Provider First Line Business Practice Location Address:
600 EAST UNAKA 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:
37601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-928-6993
Provider Business Practice Location Address Fax Number:
276-669-2159
Provider Enumeration Date:
08/30/2006