Provider First Line Business Practice Location Address:
3170 APPALACHIAN HWY
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
JACKSBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37757-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-907-1700
Provider Business Practice Location Address Fax Number:
423-907-1711
Provider Enumeration Date:
07/23/2011