Provider First Line Business Practice Location Address:
425 5TH AVE NORTH 1ST FL CORDELL
Provider Second Line Business Practice Location Address:
STATE OF TN, TB ELIMINATION PROGRAM
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37243-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-741-5885
Provider Business Practice Location Address Fax Number:
615-253-1370
Provider Enumeration Date:
03/12/2007