Provider First Line Business Practice Location Address: 
109 W WATAUGA AVE
    Provider Second Line Business Practice Location Address: 
WATAUGA BEHAVIORAL HEALTH SERVICES
    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
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
423-232-2700
    Provider Business Practice Location Address Fax Number: 
423-232-2714
    Provider Enumeration Date: 
09/12/2006