Provider First Line Business Practice Location Address:
144 MEDICAL CENTER DR STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COPPERHILL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37317-5006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-548-1520
Provider Business Practice Location Address Fax Number:
423-548-1521
Provider Enumeration Date:
01/11/2011