Provider First Line Business Practice Location Address:
807 UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
BOX 70267
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37614-6500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-439-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2011