Provider First Line Business Practice Location Address:
207 N BOONE ST
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-5675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-928-0224
Provider Business Practice Location Address Fax Number:
423-928-5209
Provider Enumeration Date:
05/25/2007