Provider First Line Business Practice Location Address:
9404 S NORTHSHORE DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37922-6549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-694-2622
Provider Business Practice Location Address Fax Number:
865-694-2650
Provider Enumeration Date:
01/09/2007