Provider First Line Business Practice Location Address:
479 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIPLEY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38063-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-635-1369
Provider Business Practice Location Address Fax Number:
731-635-0073
Provider Enumeration Date:
01/20/2006