Provider First Line Business Practice Location Address:
611 22ND ST
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:
37916-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-522-4153
Provider Business Practice Location Address Fax Number:
865-546-2042
Provider Enumeration Date:
09/22/2006