Provider First Line Business Practice Location Address:
104 UNIVERSITY PKWY STE 1
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:
37604-7349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-335-3077
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/26/2019