Provider First Line Business Practice Location Address:
301 S WATAUGA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37643-3546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-547-3840
Provider Business Practice Location Address Fax Number:
423-543-2655
Provider Enumeration Date:
09/28/2012