Provider First Line Business Practice Location Address:
1215 21ST AVE S
Provider Second Line Business Practice Location Address:
SUITE 3200, MEDICAL CENTER EAST, SOUTH TOWER
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-0014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-343-9284
Provider Business Practice Location Address Fax Number:
615-343-7645
Provider Enumeration Date:
11/16/2011