Provider First Line Business Practice Location Address:
856 MIDDLE CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEVIERVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37862-5035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-428-2193
Provider Business Practice Location Address Fax Number:
865-428-2090
Provider Enumeration Date:
03/09/2007