Provider First Line Business Practice Location Address:
8805 NEW HIGHWAY 68
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
TELLICO PLAINS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37385-5347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-253-6522
Provider Business Practice Location Address Fax Number:
423-253-3664
Provider Enumeration Date:
06/07/2006