Provider First Line Business Practice Location Address:
101 E. UNAKA AVENUE
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:
37601-4698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-283-4364
Provider Business Practice Location Address Fax Number:
423-283-4714
Provider Enumeration Date:
03/16/2006