Provider First Line Business Practice Location Address:
10992 HIGHWAY 51 S
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ATOKA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38004-4944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-837-1711
Provider Business Practice Location Address Fax Number:
901-837-1232
Provider Enumeration Date:
05/27/2006