Provider First Line Business Practice Location Address:
1400 HOLLYWOOD RD
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:
37909-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-690-4150
Provider Business Practice Location Address Fax Number:
865-330-2516
Provider Enumeration Date:
04/03/2007