Provider First Line Business Practice Location Address:
1215 21ST AVE S
Provider Second Line Business Practice Location Address:
SUITE 5209 MEDICAL CENTER EAST, SOUTH TOWER
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-8802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-343-3735
Provider Business Practice Location Address Fax Number:
615-343-4841
Provider Enumeration Date:
10/13/2006