Provider First Line Business Practice Location Address:
1328 S JB DENNIS HWY STE A
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:
37660-5495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-245-1341
Provider Business Practice Location Address Fax Number:
423-245-1164
Provider Enumeration Date:
03/27/2007