Provider First Line Business Practice Location Address:
411 W OAKLAND 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:
37604-1652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-268-2500
Provider Business Practice Location Address Fax Number:
877-805-4406
Provider Enumeration Date:
11/30/2018