Provider First Line Business Practice Location Address:
4504 BRISTOL HWY
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-3571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-952-2211
Provider Business Practice Location Address Fax Number:
423-952-2210
Provider Enumeration Date:
08/18/2009