Provider First Line Business Practice Location Address:
1161 21ST AVE S RM 1815
Provider Second Line Business Practice Location Address:
THE VANDERBILT CLINIC
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-322-6480
Provider Business Practice Location Address Fax Number:
615-322-4300
Provider Enumeration Date:
03/01/2011