Provider First Line Business Practice Location Address:
10265 KINGSTON PIKE STE B
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:
37922-3241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-539-1113
Provider Business Practice Location Address Fax Number:
865-539-0576
Provider Enumeration Date:
08/30/2006