Provider First Line Business Practice Location Address:
2428 KNOB CREEK RD STE 201
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:
37604-2396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-282-5054
Provider Business Practice Location Address Fax Number:
423-283-0516
Provider Enumeration Date:
07/17/2007