Provider First Line Business Practice Location Address:
1604 E OAKLAND AVE
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:
37601-2151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-928-2222
Provider Business Practice Location Address Fax Number:
423-926-5455
Provider Enumeration Date:
12/15/2005