Provider First Line Business Practice Location Address:
611 TOLL BRANCH RD
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:
37601-5283
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-773-9721
Provider Business Practice Location Address Fax Number:
423-743-2884
Provider Enumeration Date:
09/05/2007