Provider First Line Business Practice Location Address:
105 NORTHVIEW 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:
37919-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-588-3511
Provider Business Practice Location Address Fax Number:
865-588-2486
Provider Enumeration Date:
05/31/2005