Provider First Line Business Practice Location Address:
110 MED TECH PKWY
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-929-2111
Provider Business Practice Location Address Fax Number:
423-929-0497
Provider Enumeration Date:
05/05/2006