Provider First Line Business Practice Location Address:
200 W SPRINGDALE AVE
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:
37917-5157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-376-3515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2021