Provider First Line Business Practice Location Address:
6515 CLINTON HWY
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37912-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-455-8048
Provider Business Practice Location Address Fax Number:
865-622-5456
Provider Enumeration Date:
05/17/2010