Provider First Line Business Practice Location Address:
200 W 10TH ST
Provider Second Line Business Practice Location Address:
TN DEPT OF HEALTH
Provider Business Practice Location Address City Name:
COOKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38501-6077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-528-7531
Provider Business Practice Location Address Fax Number:
931-520-0413
Provider Enumeration Date:
03/01/2007