Provider First Line Business Practice Location Address:
2105 E CENTER ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37664-2663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-765-9911
Provider Business Practice Location Address Fax Number:
423-765-9912
Provider Enumeration Date:
05/13/2011