Provider First Line Business Practice Location Address:
3201 BRISTOL HWY
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-1565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-262-8327
Provider Business Practice Location Address Fax Number:
423-262-8329
Provider Enumeration Date:
05/03/2008