Provider First Line Business Practice Location Address:
310 N STATE OF FRANKLIN RD STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-6063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-434-3700
Provider Business Practice Location Address Fax Number:
423-929-0662
Provider Enumeration Date:
11/26/2018