Provider First Line Business Practice Location Address:
1901 S SHADY ST
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:
37683-2021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-727-1100
Provider Business Practice Location Address Fax Number:
423-727-1105
Provider Enumeration Date:
04/26/2006