Provider First Line Business Practice Location Address:
1119 SEVIER AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37920-1897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-579-1008
Provider Business Practice Location Address Fax Number:
865-579-1011
Provider Enumeration Date:
08/25/2010