Provider First Line Business Practice Location Address:
139 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADAMSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38310-2203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-632-3118
Provider Business Practice Location Address Fax Number:
731-632-0567
Provider Enumeration Date:
01/26/2007