Provider First Line Business Practice Location Address:
2717 E. OAKLAND AVENUE
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-926-2358
Provider Business Practice Location Address Fax Number:
276-258-4056
Provider Enumeration Date:
10/24/2006