Provider First Line Business Practice Location Address: 
600 ARTHUR ST
    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: 
37921-6405
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
865-523-8695
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/04/2023