Provider First Line Business Practice Location Address:
3170 APPALACHIAN HIGHWAY STE 5
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:
37757-3024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-566-4120
Provider Business Practice Location Address Fax Number:
423-566-4119
Provider Enumeration Date:
12/08/2015