Provider First Line Business Practice Location Address:
2320 KNOB CREEK RD STE 408
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:
37604-2581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-232-1969
Provider Business Practice Location Address Fax Number:
423-232-0320
Provider Enumeration Date:
01/03/2012