Provider First Line Business Practice Location Address:
305 HOTEL AVENUE
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:
37918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-688-1101
Provider Business Practice Location Address Fax Number:
865-688-1109
Provider Enumeration Date:
12/18/2006