Provider First Line Business Practice Location Address:
206 PRINCETON RD
Provider Second Line Business Practice Location Address:
STE 14
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-2058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-283-4905
Provider Business Practice Location Address Fax Number:
423-283-4200
Provider Enumeration Date:
09/20/2005