Provider First Line Business Practice Location Address:
648 EASTERN STAR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-349-9000
Provider Business Practice Location Address Fax Number:
423-349-9005
Provider Enumeration Date:
12/14/2005