Provider First Line Business Practice Location Address:
2616 OLD PARROTTSVILLE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARROTTSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37843-3350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-248-8670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2012