Provider First Line Business Practice Location Address:
701 N. STATE OF FRANKLIN ROAD
Provider Second Line Business Practice Location Address:
STE 5
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:
423-928-9285
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2012