Provider First Line Business Practice Location Address:
108 W INSKIP DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37912-4058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-687-2277
Provider Business Practice Location Address Fax Number:
865-689-5336
Provider Enumeration Date:
07/29/2005