Provider First Line Business Practice Location Address:
2001 LAUREL AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-377-7199
Provider Business Practice Location Address Fax Number:
865-637-5121
Provider Enumeration Date:
07/06/2005