Provider First Line Business Practice Location Address:
5625 HIGHWAY 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRCHWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37308-5155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-961-0446
Provider Business Practice Location Address Fax Number:
423-209-8001
Provider Enumeration Date:
12/16/2014