Provider First Line Business Practice Location Address: 
1 MEDICAL CENTER BLVD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
COOKEVILLE
    Provider Business Practice Location Address State Name: 
TN
    Provider Business Practice Location Address Postal Code: 
38501-4294
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
931-783-2334
    Provider Business Practice Location Address Fax Number: 
931-783-2253
    Provider Enumeration Date: 
10/22/2014