Provider First Line Business Practice Location Address:
408 N STATE OF FRANKLIN RD
Provider Second Line Business Practice Location Address:
SUITE 31B
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-6089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-431-4946
Provider Business Practice Location Address Fax Number:
423-431-4947
Provider Enumeration Date:
05/26/2010