Provider First Line Business Practice Location Address:
701 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38343-3034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-784-4300
Provider Business Practice Location Address Fax Number:
731-784-4308
Provider Enumeration Date:
11/12/2007