Provider First Line Business Practice Location Address:
CORNER OF SIDNEY AND LAMONT
Provider Second Line Business Practice Location Address:
JAMES H QUILLEN -VAMC
Provider Business Practice Location Address City Name:
(JOHNSON CITY) MOUNTAIN HOME
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-979-3498
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006