Provider First Line Business Practice Location Address:
6624 CENTRAL AVENUE 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:
37912-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-689-5003
Provider Business Practice Location Address Fax Number:
865-689-8956
Provider Enumeration Date:
05/27/2016