Provider First Line Business Practice Location Address:
216 W WATAUGA AVE
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:
37604-5624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-928-0265
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2022