Provider First Line Business Practice Location Address:
2340 KNOB CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 720
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:
423-926-6112
Provider Business Practice Location Address Fax Number:
423-968-1255
Provider Enumeration Date:
01/28/2015