Provider First Line Business Practice Location Address:
8112 LUSCOMBE DR
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:
37919-7009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-827-7393
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2025