Provider First Line Business Practice Location Address:
241 E WOODLAND 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:
37917-6348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-523-0491
Provider Business Practice Location Address Fax Number:
865-523-0492
Provider Enumeration Date:
12/27/2012