Provider First Line Business Practice Location Address:
5619 HIGHWAY 90
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAIRFIELD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-784-7794
Provider Business Practice Location Address Fax Number:
423-784-9974
Provider Enumeration Date:
12/30/2015