Provider First Line Business Practice Location Address:
205 E SULLIVAN ST
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:
37660-4328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-245-6189
Provider Business Practice Location Address Fax Number:
423-378-4837
Provider Enumeration Date:
10/03/2005