Provider First Line Business Practice Location Address:
203 W MAIN STREET
Provider Second Line Business Practice Location Address:
P.O. BOX 1005
Provider Business Practice Location Address City Name:
DANDRIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-339-9908
Provider Business Practice Location Address Fax Number:
865-375-2442
Provider Enumeration Date:
06/02/2015