Provider First Line Business Practice Location Address:
204 DOGWOOD AVE.
Provider Second Line Business Practice Location Address:
DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER (126)
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-926-1171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2006