Provider First Line Business Practice Location Address:
2100 W CLINCH AVE
Provider Second Line Business Practice Location Address:
SUITE 400 KOPPEL PLAZA
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-2219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-521-7998
Provider Business Practice Location Address Fax Number:
865-521-7405
Provider Enumeration Date:
10/18/2006