Provider First Line Business Practice Location Address:
301 MED TECH PKWY STE 280
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:
37604-2364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-794-5550
Provider Business Practice Location Address Fax Number:
423-928-0394
Provider Enumeration Date:
09/24/2012