Provider First Line Business Practice Location Address:
9170 STATE HWY 68
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TELLICO PLAINS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-253-2823
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2020