Provider First Line Business Practice Location Address:
113 EAST UNAKA AVENUE
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:
37601-4085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-928-9394
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2008