Provider First Line Business Practice Location Address:
460 MEDICAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
LENOIR CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37772-5640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-986-7737
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2006