Provider First Line Business Practice Location Address:
1819 CLINCH 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:
37916-2434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-546-5111
Provider Business Practice Location Address Fax Number:
865-374-2095
Provider Enumeration Date:
12/21/2010