Provider First Line Business Practice Location Address:
2001 LAUREL AVE STE N401
Provider Second Line Business Practice Location Address:
NEWLAND PROFESSIONAL BUILDING FORT SANDERS REGIONAL MC
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-531-2078
Provider Business Practice Location Address Fax Number:
865-531-2078
Provider Enumeration Date:
11/14/2006