Provider First Line Business Practice Location Address:
1277 KNOXVILLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARTBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37887-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-346-5656
Provider Business Practice Location Address Fax Number:
423-346-5242
Provider Enumeration Date:
06/29/2006