Provider First Line Business Practice Location Address:
1445 US HIGHWAY 51 BYP E
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
DYERSBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38024-2127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-286-1900
Provider Business Practice Location Address Fax Number:
731-286-1939
Provider Enumeration Date:
08/09/2005