Provider First Line Business Practice Location Address:
101 E BLOUNT 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:
37920-1601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-632-5627
Provider Business Practice Location Address Fax Number:
865-584-2165
Provider Enumeration Date:
08/31/2006