DAISY TAN ANTIQUE

JACKSON, TN
NPI1447227939
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy207R00000X Internal Medicine
(Licence: TN  39516)
Enumeration Date2006-03-02
Last Update Date2007-12-11
Business Address
-- DAISY TAN ANTIQUE MD
708 W FOREST AVE
JACKSON, TN 38301-3901
Phone number: 731-660-8759
Mailing Address
-- DAISY TAN ANTIQUE MD
1804 HIGHWAY 45 BYP SUITE 604
JACKSON, TN 38305-4436
Phone number: 731-660-8759
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