Provider First Line Business Practice Location Address:
1515 W PLEASANT ST
Provider Second Line Business Practice Location Address:
CIHCS - KNOXVILLE DIVISION
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50138-3399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-842-3101
Provider Business Practice Location Address Fax Number:
641-828-5331
Provider Enumeration Date:
07/31/2006