Provider First Line Business Practice Location Address:
1201 CARTER STREET
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37402-5089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-267-9189
Provider Business Practice Location Address Fax Number:
423-267-2244
Provider Enumeration Date:
03/23/2007