Provider First Line Business Practice Location Address:
578 S STADIUM HL
Provider Second Line Business Practice Location Address:
UT KNOXVILLE
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37996-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-974-5019
Provider Business Practice Location Address Fax Number:
865-974-1539
Provider Enumeration Date:
08/04/2010