Provider First Line Business Practice Location Address:
6311 KINGSTON PIKE
Provider Second Line Business Practice Location Address:
SUITE 8-W
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-584-7336
Provider Business Practice Location Address Fax Number:
865-584-6208
Provider Enumeration Date:
10/27/2006