Provider First Line Business Practice Location Address:
325 N STATE OF FRANKLIN RD FL 2
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-439-7280
Provider Business Practice Location Address Fax Number:
423-439-7314
Provider Enumeration Date:
12/14/2005