Provider First Line Business Practice Location Address:
600 N STATE OF FRANKLIN RD
Provider Second Line Business Practice Location Address:
STE. 15
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-8226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-929-2773
Provider Business Practice Location Address Fax Number:
423-929-7474
Provider Enumeration Date:
02/19/2007