Provider First Line Business Practice Location Address:
1000 E CENTER ST
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37660-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-378-6337
Provider Business Practice Location Address Fax Number:
423-378-6333
Provider Enumeration Date:
05/24/2005