Provider First Line Business Practice Location Address:
3904 LONAS
Provider Second Line Business Practice Location Address:
PA PROGRAM SOUTH COLLEGE
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-251-1883
Provider Business Practice Location Address Fax Number:
865-584-9816
Provider Enumeration Date:
11/16/2009