Provider First Line Business Practice Location Address:
215 E WATAUGA 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:
37601-4629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-437-3977
Provider Business Practice Location Address Fax Number:
423-491-8109
Provider Enumeration Date:
01/03/2007