Provider First Line Business Practice Location Address:
1392 E CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37664-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-378-4907
Provider Business Practice Location Address Fax Number:
423-578-8204
Provider Enumeration Date:
09/25/2006