Provider First Line Business Practice Location Address:
2913 BOONES CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37615-4997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-952-2340
Provider Business Practice Location Address Fax Number:
423-952-2351
Provider Enumeration Date:
05/04/2006