Provider First Line Business Practice Location Address:
2328 KNOB CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 506
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-2584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-722-1311
Provider Business Practice Location Address Fax Number:
423-926-0529
Provider Enumeration Date:
07/02/2006