Provider First Line Business Practice Location Address:
11151 KINGSTON PIKE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37934-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-675-2050
Provider Business Practice Location Address Fax Number:
865-675-2051
Provider Enumeration Date:
08/08/2006