Provider First Line Business Practice Location Address:
3006 ELAM CENTER
Provider Second Line Business Practice Location Address:
UT MARTIN
Provider Business Practice Location Address City Name:
MARTIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38238-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-881-7339
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2006