Provider First Line Business Practice Location Address:
1761 HIGHWAY 95 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENBACK
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37742-4245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-856-2320
Provider Business Practice Location Address Fax Number:
865-856-9103
Provider Enumeration Date:
11/02/2005