Provider First Line Business Practice Location Address:
2811 W MARKET STREET
Provider Second Line Business Practice Location Address:
STE 5
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-928-8004
Provider Business Practice Location Address Fax Number:
423-928-8008
Provider Enumeration Date:
08/08/2006