Provider First Line Business Practice Location Address:
109 NORTHSHORE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200
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:
865-384-6963
Provider Business Practice Location Address Fax Number:
865-251-1151
Provider Enumeration Date:
12/18/2007