Provider First Line Business Practice Location Address:
3211 PEOPLES ST
Provider Second Line Business Practice Location Address:
STE 55
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-328-5189
Provider Business Practice Location Address Fax Number:
423-952-4953
Provider Enumeration Date:
01/04/2016