Provider First Line Business Practice Location Address:
509 BARREN VALLEY RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHUCKEY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-552-0583
Provider Business Practice Location Address Fax Number:
423-257-3724
Provider Enumeration Date:
11/29/2005