Provider First Line Business Practice Location Address:
1596 HIGHWAY 33 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW TAZEWELL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37825-7104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-626-8271
Provider Business Practice Location Address Fax Number:
423-626-0688
Provider Enumeration Date:
08/05/2011