Provider First Line Business Practice Location Address:
817 W WALNUT ST
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-6549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-262-8300
Provider Business Practice Location Address Fax Number:
423-262-8786
Provider Enumeration Date:
06/11/2006