Provider First Line Business Practice Location Address:
325 N. STATE OF FRANKLIN ROAD, GROUND FLOOR
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:
37604-6062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-439-7320
Provider Business Practice Location Address Fax Number:
423-739-7343
Provider Enumeration Date:
08/07/2014