Provider First Line Business Practice Location Address:
8805 KINGSTON PIKE
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37923-5099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-693-1911
Provider Business Practice Location Address Fax Number:
865-693-1911
Provider Enumeration Date:
10/27/2006