Provider First Line Business Practice Location Address:
7794 RHEA COUNTY HWY
Provider Second Line Business Practice Location Address:
MEDIVCAL PROFESSIONAL BUILDING, SUITE 102
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37321-5981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-775-6550
Provider Business Practice Location Address Fax Number:
423-775-6689
Provider Enumeration Date:
08/24/2006