Provider First Line Business Practice Location Address:
334 HIGHWAY 92 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 1
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:
865-397-5422
Provider Business Practice Location Address Fax Number:
865-397-5432
Provider Enumeration Date:
02/03/2011