Provider First Line Business Practice Location Address:
837 PARDEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-439-4355
Provider Business Practice Location Address Fax Number:
423-439-4607
Provider Enumeration Date:
07/02/2008