Provider First Line Business Practice Location Address:
11630 HIGHWAY 51 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATOKA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38004-7129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-837-5010
Provider Business Practice Location Address Fax Number:
901-837-5014
Provider Enumeration Date:
09/11/2006