Provider First Line Business Practice Location Address:
1805 W STATE OF FRANKLIN 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:
37604-8801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-929-1409
Provider Business Practice Location Address Fax Number:
423-929-1442
Provider Enumeration Date:
09/16/2009