Provider First Line Business Practice Location Address:
2306 KNOB CREEK RD STE 104
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:
37604-2366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-794-7490
Provider Business Practice Location Address Fax Number:
423-735-0289
Provider Enumeration Date:
11/07/2005