Provider First Line Business Practice Location Address:
6110 SHALLOWFORD RD
Provider Second Line Business Practice Location Address:
CRC
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37421-1894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-512-1878
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2009