Provider First Line Business Practice Location Address:
988 OAK RIDGE TPKE
Provider Second Line Business Practice Location Address:
SUITE 200, PHYSICIANS PLAZA
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:
865-483-4366
Provider Business Practice Location Address Fax Number:
865-483-5957
Provider Enumeration Date:
08/30/2005