Provider First Line Business Practice Location Address:
1640 W CLINCH AVE
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:
37916-2524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-637-5848
Provider Business Practice Location Address Fax Number:
865-525-4026
Provider Enumeration Date:
04/10/2007