Provider First Line Business Practice Location Address:
1216 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:
37604-6568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-534-7957
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2024