Provider First Line Business Practice Location Address:
116 FRANK MARTIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37160-7192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-685-4060
Provider Business Practice Location Address Fax Number:
931-685-4062
Provider Enumeration Date:
05/26/2026