Provider First Line Business Practice Location Address:
1497 W ELK AVE
Provider Second Line Business Practice Location Address:
SUITE 21
Provider Business Practice Location Address City Name:
ELIZABETHTON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37643-2895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-542-7420
Provider Business Practice Location Address Fax Number:
423-542-7425
Provider Enumeration Date:
05/11/2006