Provider First Line Business Practice Location Address:
2335 KNOB CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-282-1030
Provider Business Practice Location Address Fax Number:
423-282-4714
Provider Enumeration Date:
04/08/2014