Provider First Line Business Practice Location Address:
1107 N ROAN ST
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:
37601-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-926-7333
Provider Business Practice Location Address Fax Number:
423-926-6222
Provider Enumeration Date:
12/15/2006