Provider First Line Business Practice Location Address:
140 WEST TENNESSEE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-482-1097
Provider Business Practice Location Address Fax Number:
865-482-5309
Provider Enumeration Date:
12/16/2005