Provider First Line Business Practice Location Address:
310 N STATE OF FRANKLIN RD
Provider Second Line Business Practice Location Address:
STE 101
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-929-7393
Provider Business Practice Location Address Fax Number:
423-929-1427
Provider Enumeration Date:
03/27/2006