Provider First Line Business Practice Location Address:
209 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:
37601-4625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-434-4677
Provider Business Practice Location Address Fax Number:
423-434-4645
Provider Enumeration Date:
05/09/2007