Provider First Line Business Practice Location Address:
11407 COUCH MILL RD
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:
37931-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-927-2220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2006