Provider First Line Business Practice Location Address:
108 HIGHWAY 25 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37821-0802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-623-4242
Provider Business Practice Location Address Fax Number:
423-623-4272
Provider Enumeration Date:
06/06/2006