Provider First Line Business Practice Location Address:
1850 OLD KNOXVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAZEWELL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37879-3625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-626-4211
Provider Business Practice Location Address Fax Number:
423-626-9926
Provider Enumeration Date:
06/15/2005