Provider First Line Business Practice Location Address:
526 LAMAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37917-7343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-544-3841
Provider Business Practice Location Address Fax Number:
865-541-3843
Provider Enumeration Date:
05/21/2008