Provider First Line Business Practice Location Address:
410 N STATE OF FRANKLIN RD STE 130
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:
37604-6972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-431-2477
Provider Business Practice Location Address Fax Number:
423-431-2478
Provider Enumeration Date:
01/22/2018