Provider First Line Business Practice Location Address:
1161 21ST AVE S
Provider Second Line Business Practice Location Address:
CC-3322 MEDICAL CENTER NORTH
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-2561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-343-4882
Provider Business Practice Location Address Fax Number:
615-322-0576
Provider Enumeration Date:
04/15/2014