Provider First Line Business Practice Location Address:
1161 21ST AVENUE SOUTH
Provider Second Line Business Practice Location Address:
MEDICAL CENTER NORTH, SUITE CCC-4312
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-2730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-343-6642
Provider Business Practice Location Address Fax Number:
615-322-0689
Provider Enumeration Date:
04/12/2019