Provider First Line Business Practice Location Address:
3755 E ANDREW JOHNSON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37745-1084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-639-7139
Provider Business Practice Location Address Fax Number:
423-639-7101
Provider Enumeration Date:
07/16/2006