Provider First Line Business Practice Location Address:
1202 S JAMES CAMPBELL BLVD
Provider Second Line Business Practice Location Address:
SUITE 22
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38401-5193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-380-2484
Provider Business Practice Location Address Fax Number:
931-540-8147
Provider Enumeration Date:
11/17/2006