Provider First Line Business Practice Location Address:
5009 E GOVERNOR JOHN SEVIER HWY
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:
37914-6124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-356-5049
Provider Business Practice Location Address Fax Number:
865-522-4992
Provider Enumeration Date:
04/30/2020