Provider First Line Business Practice Location Address:
3209 BRISTOL HWY
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:
37601-1515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-282-3311
Provider Business Practice Location Address Fax Number:
423-282-5245
Provider Enumeration Date:
11/25/2014