Provider First Line Business Practice Location Address:
2102 E ANDREW JOHNSON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37814-5412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-307-1890
Provider Business Practice Location Address Fax Number:
423-307-1891
Provider Enumeration Date:
06/27/2007