Provider First Line Business Practice Location Address:
146 W PARK DR
Provider Second Line Business Practice Location Address:
SUITE 9B
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37660-3824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-246-3220
Provider Business Practice Location Address Fax Number:
423-246-3221
Provider Enumeration Date:
03/23/2006