Provider First Line Business Practice Location Address:
2312 KNOB CREEK RD STE 208
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:
37604-2367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-610-1099
Provider Business Practice Location Address Fax Number:
423-246-4300
Provider Enumeration Date:
05/17/2011