Provider First Line Business Practice Location Address:
2620 MINERAL SPRINGS AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37917-1569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-591-4703
Provider Business Practice Location Address Fax Number:
865-288-3303
Provider Enumeration Date:
12/15/2005