Provider First Line Business Practice Location Address:
301 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 200, TENNESSEE DEPARTMENT OF HEALTH
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37190-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-563-4243
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007