Provider First Line Business Practice Location Address:
1804 MAIN STREET
Provider Second Line Business Practice Location Address:
RAINBOW PEDIATRIC
Provider Business Practice Location Address City Name:
HUMBOLDT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-784-7833
Provider Business Practice Location Address Fax Number:
731-784-7856
Provider Enumeration Date:
07/11/2011