Provider First Line Business Practice Location Address:
6300 BAUM DR STE A
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:
37919-9505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-584-9309
Provider Business Practice Location Address Fax Number:
865-584-7576
Provider Enumeration Date:
08/31/2006