Provider First Line Business Practice Location Address:
411 PRINCETON RD.
Provider Second Line Business Practice Location Address:
SUITE 101
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-282-1171
Provider Business Practice Location Address Fax Number:
423-282-1181
Provider Enumeration Date:
12/08/2011