Provider First Line Business Practice Location Address:
6311 KINGSTON PIKE
Provider Second Line Business Practice Location Address:
STE 27W
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:
865-588-7862
Provider Business Practice Location Address Fax Number:
865-558-6849
Provider Enumeration Date:
10/02/2006