Provider First Line Business Practice Location Address:
807 UNIVERSITY PKWY
Provider Second Line Business Practice Location Address:
ETSU CAMPUS LAMB HALL ROOM 361
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37614-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-439-4355
Provider Business Practice Location Address Fax Number:
423-439-4607
Provider Enumeration Date:
01/05/2007