Provider First Line Business Practice Location Address:
4050 HIGHWAY 67 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37683-6013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-727-5421
Provider Business Practice Location Address Fax Number:
423-727-5018
Provider Enumeration Date:
04/28/2006