Provider First Line Business Practice Location Address:
10810 PARKSIDE DR
Provider Second Line Business Practice Location Address:
PHYSICIANS PLAZA 1, SUITE 305
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37934-1979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-694-9676
Provider Business Practice Location Address Fax Number:
865-588-3742
Provider Enumeration Date:
06/08/2006