Provider First Line Business Practice Location Address:
1031 ELEANOR 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:
37917-6641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-607-1031
Provider Business Practice Location Address Fax Number:
865-523-4818
Provider Enumeration Date:
11/20/2005