Provider First Line Business Practice Location Address:
2829 E OAKLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-1347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-283-4590
Provider Business Practice Location Address Fax Number:
423-283-0867
Provider Enumeration Date:
09/14/2006