Provider First Line Business Practice Location Address:
800 NEW HIGHWAY 68
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWEETWATER
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37874-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-337-9381
Provider Business Practice Location Address Fax Number:
423-337-9382
Provider Enumeration Date:
08/18/2006