Provider First Line Business Practice Location Address:
3915 BRISTOL HWY
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-283-7533
Provider Business Practice Location Address Fax Number:
423-283-7532
Provider Enumeration Date:
12/04/2006