Provider First Line Business Practice Location Address:
2121 MEDICAL CENTRE WAY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-337-3051
Provider Business Practice Location Address Fax Number:
606-337-2871
Provider Enumeration Date:
09/14/2005