Provider First Line Business Practice Location Address:
1335 E CENTER ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37664-2489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-247-2263
Provider Business Practice Location Address Fax Number:
423-434-0818
Provider Enumeration Date:
06/06/2008