Provider First Line Business Practice Location Address:
6515 CLINTON HWY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37912-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-332-0166
Provider Business Practice Location Address Fax Number:
888-862-6234
Provider Enumeration Date:
08/21/2008