Provider First Line Business Practice Location Address:
2320 KNOB CREEK RD STE 404
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:
37604-2581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-661-7445
Provider Business Practice Location Address Fax Number:
423-224-3709
Provider Enumeration Date:
01/14/2016