Provider First Line Business Practice Location Address:
D-4207 MEDICAL CTR N
Provider Second Line Business Practice Location Address:
VANDERBILT UNIVERSITY MEDICAL CENTER
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:
615-936-3759
Provider Business Practice Location Address Fax Number:
615-936-0167
Provider Enumeration Date:
10/25/2006