Provider First Line Business Practice Location Address:
2685 BOONES CREEK RD
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37615-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-282-6337
Provider Business Practice Location Address Fax Number:
423-282-5264
Provider Enumeration Date:
08/20/2006