Provider First Line Business Practice Location Address:
900 W BAXTER 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:
37921-6851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-525-9833
Provider Business Practice Location Address Fax Number:
865-525-2192
Provider Enumeration Date:
06/27/2006