Provider First Line Business Practice Location Address:
119 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGDON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38344-0672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-986-4737
Provider Business Practice Location Address Fax Number:
731-986-4737
Provider Enumeration Date:
12/01/2006