Provider First Line Business Practice Location Address:
4303 CENTRAL AVE.PIKE
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:
37912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-247-7045
Provider Business Practice Location Address Fax Number:
865-249-8458
Provider Enumeration Date:
04/24/2013