Provider First Line Business Practice Location Address:
109 W WATAUGA
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:
37605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-232-2700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006