Provider First Line Business Practice Location Address:
EAST TN STATE UNIV., DEPT. OF PATHOLOGY, VAMC, BLDG. 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN HOME
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-439-6210
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2012