Provider First Line Business Practice Location Address:
2240 SUTHERLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-771-9119
Provider Business Practice Location Address Fax Number:
865-329-3362
Provider Enumeration Date:
12/10/2010