Provider First Line Business Practice Location Address:
325 N STATE OF FRANKLIN ROAD
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:
37604-6066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-439-6283
Provider Business Practice Location Address Fax Number:
423-439-6386
Provider Enumeration Date:
05/19/2020