Provider First Line Business Practice Location Address:
1906 KNOB CREEK RD STE 1
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:
37604-3097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-282-5223
Provider Business Practice Location Address Fax Number:
423-282-4479
Provider Enumeration Date:
09/26/2006