Provider First Line Business Practice Location Address:
110 UNIVERSITY PKWY APT 1
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:
37604-7334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-926-9100
Provider Business Practice Location Address Fax Number:
423-926-9200
Provider Enumeration Date:
11/17/2006