Provider First Line Business Practice Location Address:
895 E ANDREW JOHNSON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37745-3581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-639-0871
Provider Business Practice Location Address Fax Number:
423-639-4429
Provider Enumeration Date:
07/26/2007