Provider First Line Business Practice Location Address:
600 N STATE OF FRANKLIN RD
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-8226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-220-1266
Provider Business Practice Location Address Fax Number:
866-404-0950
Provider Enumeration Date:
08/05/2016