Provider First Line Business Practice Location Address:
2306 KNOB CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-2366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-929-2020
Provider Business Practice Location Address Fax Number:
423-929-3140
Provider Enumeration Date:
09/14/2006