Provider First Line Business Practice Location Address:
801 SCHOOL ST
Provider Second Line Business Practice Location Address:
STE 598 CENTER STONE ASSOC
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38402-0598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-490-1460
Provider Business Practice Location Address Fax Number:
931-490-1472
Provider Enumeration Date:
11/30/2006