Provider First Line Business Practice Location Address:
146 BUCK CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROAN MOUNTAIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-772-0161
Provider Business Practice Location Address Fax Number:
423-772-3481
Provider Enumeration Date:
12/01/2005