Provider First Line Business Practice Location Address:
1915 WHITE 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:
37916-2399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-331-1155
Provider Business Practice Location Address Fax Number:
865-331-1801
Provider Enumeration Date:
11/19/2012