Provider First Line Business Practice Location Address:
1331 MILLIGAN HWY
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:
37601-5511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-926-3311
Provider Business Practice Location Address Fax Number:
423-926-3311
Provider Enumeration Date:
10/12/2006