Provider First Line Business Practice Location Address:
323 W WALNUT ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-6760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-378-0011
Provider Business Practice Location Address Fax Number:
423-246-0311
Provider Enumeration Date:
05/16/2007