Provider First Line Business Practice Location Address:
120 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
JEFFERSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37760-5287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-471-0312
Provider Business Practice Location Address Fax Number:
865-475-2802
Provider Enumeration Date:
02/09/2012