Provider First Line Business Practice Location Address:
3 PROFESSIONAL PARK DR
Provider Second Line Business Practice Location Address:
SUITE 21
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-434-6300
Provider Business Practice Location Address Fax Number:
423-926-6713
Provider Enumeration Date:
11/01/2012