Provider First Line Business Practice Location Address:
600 E UNAKA AVE
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:
37601-4035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-928-4003
Provider Business Practice Location Address Fax Number:
423-772-3689
Provider Enumeration Date:
05/21/2007