Provider First Line Business Practice Location Address:
310 N STATE OF FRANKLIN RD
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-6008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-926-8181
Provider Business Practice Location Address Fax Number:
423-926-4421
Provider Enumeration Date:
04/18/2007