Provider First Line Business Practice Location Address: 
725 E POPLAR AVE
    Provider Second Line Business Practice Location Address: 
MCNAIRY COUNTY HEALTH DEPARTMENT
    Provider Business Practice Location Address City Name: 
SELMER
    Provider Business Practice Location Address State Name: 
TN
    Provider Business Practice Location Address Postal Code: 
38375-1800
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
731-645-3474
    Provider Business Practice Location Address Fax Number: 
731-645-4530
    Provider Enumeration Date: 
02/23/2007