Provider First Line Business Practice Location Address:
12186 PAW PAW PLAINS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37771-3510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-639-0941
Provider Business Practice Location Address Fax Number:
423-638-3401
Provider Enumeration Date:
11/02/2017