Provider First Line Business Practice Location Address:
2908 TAZEWELL PIKE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37918-1878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-219-6055
Provider Business Practice Location Address Fax Number:
865-982-5185
Provider Enumeration Date:
09/06/2006