Provider First Line Business Practice Location Address:
300 MED TECH PKWY
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:
37604-2277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-431-1810
Provider Business Practice Location Address Fax Number:
423-431-1811
Provider Enumeration Date:
11/12/2007