Provider First Line Business Practice Location Address:
2313 EAST CENTER ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37664-2798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-247-4400
Provider Business Practice Location Address Fax Number:
423-247-4404
Provider Enumeration Date:
08/06/2007