Provider First Line Business Practice Location Address:
4405 CENTRAL AVENUE PIKE STE 102
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:
37912-4078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-315-7479
Provider Business Practice Location Address Fax Number:
865-315-7479
Provider Enumeration Date:
04/24/2007