Provider First Line Business Practice Location Address:
900 BUFFALO ST
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:
37604-6720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-232-4130
Provider Business Practice Location Address Fax Number:
423-232-4145
Provider Enumeration Date:
08/04/2008