Provider First Line Business Practice Location Address:
2753 E CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37664-2715
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-246-7121
Provider Business Practice Location Address Fax Number:
423-246-8510
Provider Enumeration Date:
11/15/2012