Provider First Line Business Practice Location Address:
300 PROSPERITY RD STE 103
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:
37923-4717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-246-0143
Provider Business Practice Location Address Fax Number:
865-246-0146
Provider Enumeration Date:
03/15/2013