Provider First Line Business Practice Location Address:
509 N STATE OF FRANKLIN RD
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-8214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-232-8885
Provider Business Practice Location Address Fax Number:
423-232-8862
Provider Enumeration Date:
03/29/2007