Provider First Line Business Practice Location Address:
1450 N MACK SMITH RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
EAST RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37412-3948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-752-5002
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2010