Provider First Line Business Practice Location Address:
188 HOSPITAL LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JELLICO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-944-7252
Provider Business Practice Location Address Fax Number:
423-784-1136
Provider Enumeration Date:
05/02/2006