Provider First Line Business Practice Location Address:
527 N. STATE OF FRANKLIN RD.
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-8210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-926-3338
Provider Business Practice Location Address Fax Number:
423-926-0567
Provider Enumeration Date:
08/10/2006