Provider First Line Business Practice Location Address:
1233 SOUTHWEST 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:
37604-6596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-979-4669
Provider Business Practice Location Address Fax Number:
423-979-3267
Provider Enumeration Date:
04/10/2008