Provider First Line Business Practice Location Address:
229 HIGHWAY 19 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUFF CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37618-1865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-538-5116
Provider Business Practice Location Address Fax Number:
423-538-3861
Provider Enumeration Date:
07/22/2005