Provider First Line Business Practice Location Address:
8295 HIGHWAY 131
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHBURN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37888
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-497-9999
Provider Business Practice Location Address Fax Number:
865-497-9990
Provider Enumeration Date:
09/19/2005