Provider First Line Business Practice Location Address:
1242 W SHIPLEY FERRY 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:
37663-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-239-7300
Provider Business Practice Location Address Fax Number:
423-239-7607
Provider Enumeration Date:
08/20/2007