Provider First Line Business Practice Location Address:
2808 E CENTER ST
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:
37664-2718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-782-8957
Provider Business Practice Location Address Fax Number:
423-246-8699
Provider Enumeration Date:
05/23/2007