Provider First Line Business Practice Location Address:
401 TAKOMA AVE
Provider Second Line Business Practice Location Address:
C/O TAKOMA REGIONAL HOSPITAL
Provider Business Practice Location Address City Name:
GREENEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37743-4647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-636-0718
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2008