Provider First Line Business Practice Location Address:
215 E WATAUGA AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-4629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-388-3643
Provider Business Practice Location Address Fax Number:
423-388-3561
Provider Enumeration Date:
09/27/2006