Provider First Line Business Practice Location Address:
417 GREENLEE RD
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:
37601-7064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-302-0205
Provider Business Practice Location Address Fax Number:
423-220-8582
Provider Enumeration Date:
10/23/2023