Provider First Line Business Practice Location Address:
1009 N STATE OF FRANKLIN ACCESS ROAD
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:
37604-3693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-929-7546
Provider Business Practice Location Address Fax Number:
423-929-7968
Provider Enumeration Date:
08/10/2005