Provider First Line Business Practice Location Address:
6624 CENTRAL AVENUE PIKE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37912-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-851-9023
Provider Business Practice Location Address Fax Number:
865-951-1966
Provider Enumeration Date:
10/17/2016