Provider First Line Business Practice Location Address:
55 NURSING HOME RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHUCKEY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-257-6761
Provider Business Practice Location Address Fax Number:
423-257-4936
Provider Enumeration Date:
04/04/2006