Provider First Line Business Practice Location Address:
2831 E OAKLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-631-0340
Provider Business Practice Location Address Fax Number:
423-631-0342
Provider Enumeration Date:
04/05/2012