Provider First Line Business Practice Location Address:
3088 APPALACHIAN HWY STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37757-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-566-8248
Provider Business Practice Location Address Fax Number:
423-566-8247
Provider Enumeration Date:
06/20/2011