Provider First Line Business Practice Location Address:
400 N STATE OF FRANKLIN RD
Provider Second Line Business Practice Location Address:
ROOM 2746
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-6035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-431-2727
Provider Business Practice Location Address Fax Number:
423-431-6715
Provider Enumeration Date:
05/29/2008