Provider First Line Business Practice Location Address: 
110 KITTRELL STREET
    Provider Second Line Business Practice Location Address: 
HIGH FOREST HEALTH GROUP
    Provider Business Practice Location Address City Name: 
HOHENWALD
    Provider Business Practice Location Address State Name: 
TN
    Provider Business Practice Location Address Postal Code: 
38462
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
931-796-1818
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
12/11/2012