Provider First Line Business Practice Location Address:
6766 W JOHNSON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOSHEIM
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-422-9099
Provider Business Practice Location Address Fax Number:
423-422-9760
Provider Enumeration Date:
10/26/2006