Provider First Line Business Practice Location Address:
815 MERCHANT 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:
37912-3817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-688-0388
Provider Business Practice Location Address Fax Number:
865-688-1248
Provider Enumeration Date:
02/12/2007