Provider First Line Business Practice Location Address:
329 N 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:
37604-6062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-979-4100
Provider Business Practice Location Address Fax Number:
423-979-4134
Provider Enumeration Date:
07/10/2006