Provider First Line Business Practice Location Address:
6404 S YORK HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKRANGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38553-5138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-863-3779
Provider Business Practice Location Address Fax Number:
888-400-1390
Provider Enumeration Date:
08/10/2006