Provider First Line Business Practice Location Address:
2307 W ANDREW JOHNSON HWY
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
MORRISTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37814-3298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-581-6955
Provider Business Practice Location Address Fax Number:
423-581-2200
Provider Enumeration Date:
08/25/2005