Provider First Line Business Practice Location Address:
1047 HIGHWAY 92 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANDRIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37725-4740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-397-5073
Provider Business Practice Location Address Fax Number:
865-397-7846
Provider Enumeration Date:
08/21/2024