Provider First Line Business Practice Location Address:
150 CLINIC DR STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37663-2254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-726-2668
Provider Business Practice Location Address Fax Number:
423-726-2667
Provider Enumeration Date:
07/05/2012