Provider First Line Business Practice Location Address:
6701 BAUM DR
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919-7360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-231-9330
Provider Business Practice Location Address Fax Number:
865-450-9904
Provider Enumeration Date:
05/28/2014