Provider First Line Business Practice Location Address:
1901 S. SHADY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37683-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-727-1150
Provider Business Practice Location Address Fax Number:
423-727-1134
Provider Enumeration Date:
10/30/2013