Provider First Line Business Practice Location Address:
5401 CENTRAL AVENUE PIKE
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:
37912-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-687-0216
Provider Business Practice Location Address Fax Number:
865-687-0216
Provider Enumeration Date:
04/24/2009