Provider First Line Business Practice Location Address:
600 N STATE OF FRANKLIN RD
Provider Second Line Business Practice Location Address:
SUITE 5
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:
423-232-5295
Provider Business Practice Location Address Fax Number:
423-232-9295
Provider Enumeration Date:
07/29/2011