Provider First Line Business Practice Location Address:
300 W WATAUGA AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-5549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-232-7343
Provider Business Practice Location Address Fax Number:
423-232-7337
Provider Enumeration Date:
07/10/2014