Provider First Line Business Practice Location Address:
6145 TEMPLE STAR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37660-8028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-928-6581
Provider Business Practice Location Address Fax Number:
423-928-6215
Provider Enumeration Date:
08/26/2005