Provider First Line Business Practice Location Address:
988 OAK RIDGE TPKE
Provider Second Line Business Practice Location Address:
PHYSICIANS PLAZA STE 120
Provider Business Practice Location Address City Name:
OAK RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37830-6930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-482-4028
Provider Business Practice Location Address Fax Number:
865-481-3257
Provider Enumeration Date:
07/24/2006