Provider First Line Business Practice Location Address:
22576 RHEA COUNTY HWY
Provider Second Line Business Practice Location Address:
STE. 1, 2 & 3
Provider Business Practice Location Address City Name:
SPRING CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37381-5393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-365-4486
Provider Business Practice Location Address Fax Number:
423-822-5464
Provider Enumeration Date:
08/24/2005