Provider First Line Business Practice Location Address:
505 E UNAKA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-4032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-612-1064
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2007