Provider First Line Business Practice Location Address:
2210 HIGHWAY 63
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUMBERLAND GAP
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37724-4254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-919-9986
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2026