Provider First Line Business Practice Location Address:
1802 DECATUR PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37303-4984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-744-0282
Provider Business Practice Location Address Fax Number:
423-745-9653
Provider Enumeration Date:
03/27/2010