Provider First Line Business Practice Location Address:
2333 KNOB CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 16
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-975-0764
Provider Business Practice Location Address Fax Number:
423-975-0141
Provider Enumeration Date:
09/26/2005