Provider First Line Business Practice Location Address:
147 DURWOOD RD
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:
37922-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-691-4289
Provider Business Practice Location Address Fax Number:
865-531-1962
Provider Enumeration Date:
03/09/2007