Provider First Line Business Practice Location Address:
136 W SPRINGBROOK DR
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:
37604-1758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-764-5000
Provider Business Practice Location Address Fax Number:
423-764-5007
Provider Enumeration Date:
05/26/2010