Provider First Line Business Practice Location Address:
1161 21ST AVE. SOUTH
Provider Second Line Business Practice Location Address:
DD-2205 MEDICAL CENTER NORTH
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-2578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-343-6761
Provider Business Practice Location Address Fax Number:
615-343-0959
Provider Enumeration Date:
01/23/2023