Provider First Line Business Practice Location Address:
926 W OAKLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 226
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-1445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-929-0300
Provider Business Practice Location Address Fax Number:
423-926-8840
Provider Enumeration Date:
10/03/2006