Provider First Line Business Practice Location Address:
1304 CORDOBA 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:
37923-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-951-0523
Provider Business Practice Location Address Fax Number:
865-974-5629
Provider Enumeration Date:
06/30/2010