Provider First Line Business Practice Location Address:
1233 SOUTHWEST AVE. EXTENSION
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:
37604-6519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-979-3200
Provider Business Practice Location Address Fax Number:
423-979-3267
Provider Enumeration Date:
12/21/2006