Provider First Line Business Practice Location Address:
1615 W MARKET ST STE A
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:
37604-4904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-928-8387
Provider Business Practice Location Address Fax Number:
423-928-6320
Provider Enumeration Date:
11/24/2009