Provider First Line Business Practice Location Address:
105 IODENT WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37643-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-542-8421
Provider Business Practice Location Address Fax Number:
423-543-4323
Provider Enumeration Date:
09/01/2005