Provider First Line Business Practice Location Address:
10265 KINGSTON PIKE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-693-4150
Provider Business Practice Location Address Fax Number:
865-693-4503
Provider Enumeration Date:
01/23/2007