Provider First Line Business Practice Location Address: 
9330 PARK WEST BLVD STE 100
    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: 
37923-4309
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
865-373-7942
    Provider Business Practice Location Address Fax Number: 
865-373-7235
    Provider Enumeration Date: 
07/17/2023