Provider First Line Business Practice Location Address:
501 W OAKLAND AVE
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-1666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-283-1300
Provider Business Practice Location Address Fax Number:
423-283-1306
Provider Enumeration Date:
08/10/2006