Provider First Line Business Practice Location Address: 
2140 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: 
37745-5808
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
423-638-2226
    Provider Business Practice Location Address Fax Number: 
423-638-2299
    Provider Enumeration Date: 
10/22/2009