Provider First Line Business Practice Location Address:
1721 UPPINGHAM DR
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:
37918-2860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-323-5153
Provider Business Practice Location Address Fax Number:
865-689-2425
Provider Enumeration Date:
02/14/2013