Provider First Line Business Practice Location Address:
2333 KNOB CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 11
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-952-0500
Provider Business Practice Location Address Fax Number:
423-950-0005
Provider Enumeration Date:
07/20/2006