Provider First Line Business Practice Location Address:
1041 E. SULLIVAN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSPORT
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-224-1600
Provider Business Practice Location Address Fax Number:
423-224-1640
Provider Enumeration Date:
05/11/2007