Provider First Line Business Practice Location Address:
1303 E CENTER 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:
37664-2444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-384-9266
Provider Business Practice Location Address Fax Number:
423-239-9649
Provider Enumeration Date:
02/13/2008