Provider First Line Business Practice Location Address:
1303 CARROLL CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37615-4674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-232-0747
Provider Business Practice Location Address Fax Number:
423-328-7749
Provider Enumeration Date:
06/28/2010