Provider First Line Business Practice Location Address:
807 UNIVERSITY PARKWAY
Provider Second Line Business Practice Location Address:
ROY S NICKS HALL ROOM 160
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37614-7114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-439-4225
Provider Business Practice Location Address Fax Number:
423-439-5999
Provider Enumeration Date:
07/31/2006