Provider First Line Business Practice Location Address:
1196 CEDAR FORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAZEWELL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37879-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-869-8111
Provider Business Practice Location Address Fax Number:
423-869-5700
Provider Enumeration Date:
01/24/2006