Provider First Line Business Practice Location Address:
1162 21ST AVENUE SOUTH MEDICAL CENTER NORTH D2106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-322-8917
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2017