Provider First Line Business Practice Location Address: 
1930 ALCOA HWY BLDG A
    Provider Second Line Business Practice Location Address: 
SUITE 240
    Provider Business Practice Location Address City Name: 
KNOXVILLE
    Provider Business Practice Location Address State Name: 
TN
    Provider Business Practice Location Address Postal Code: 
37920-1500
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
865-305-9620
    Provider Business Practice Location Address Fax Number: 
865-525-3460
    Provider Enumeration Date: 
07/12/2006