Provider First Line Business Practice Location Address:
1915 WHITE AVE
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:
37916-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-541-1720
Provider Business Practice Location Address Fax Number:
865-541-1747
Provider Enumeration Date:
01/15/2009