Provider First Line Business Practice Location Address:
6845 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:
38553-5154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-863-3323
Provider Business Practice Location Address Fax Number:
931-863-3343
Provider Enumeration Date:
11/04/2015