Provider First Line Business Practice Location Address:
768 WEST ELK AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37643-2559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-542-2002
Provider Business Practice Location Address Fax Number:
423-542-2023
Provider Enumeration Date:
02/26/2007