Provider First Line Business Practice Location Address:
1109 E REELFOOT AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38261-5856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-884-2140
Provider Business Practice Location Address Fax Number:
731-884-8998
Provider Enumeration Date:
08/17/2006