Provider First Line Business Practice Location Address:
148 COUNTY ROAD 654
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37303-6210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-745-5163
Provider Business Practice Location Address Fax Number:
423-507-8099
Provider Enumeration Date:
06/30/2006