Provider First Line Business Practice Location Address:
2908 TAZEWELL PIKE
Provider Second Line Business Practice Location Address:
SUITE N
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37918-1878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-686-1646
Provider Business Practice Location Address Fax Number:
865-522-6394
Provider Enumeration Date:
09/23/2006