Provider First Line Business Practice Location Address:
1109 E REELFOOT AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38261-5866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-271-1000
Provider Business Practice Location Address Fax Number:
901-271-4187
Provider Enumeration Date:
07/07/2005