Provider First Line Business Practice Location Address:
1610 TAZEWELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAZEWELL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37879-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-588-8229
Provider Business Practice Location Address Fax Number:
865-212-0163
Provider Enumeration Date:
09/27/2011