Provider First Line Business Practice Location Address:
6714 CENTRAL AVENUE PIKE STE H
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:
37912-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-696-2775
Provider Business Practice Location Address Fax Number:
865-558-6131
Provider Enumeration Date:
11/27/2007