Provider First Line Business Practice Location Address:
1720 CHURCH ST STE 4
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:
37879-3004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-626-2410
Provider Business Practice Location Address Fax Number:
423-626-2591
Provider Enumeration Date:
05/11/2006