Provider First Line Business Practice Location Address:
CORNER OF SYDNEY AND LAMONT STREET
Provider Second Line Business Practice Location Address:
PRIMARY CARE BLDG 160
Provider Business Practice Location Address City Name:
MOUNTAIN HOME
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-926-1171
Provider Business Practice Location Address Fax Number:
423-979-3528
Provider Enumeration Date:
02/06/2008