Provider First Line Business Practice Location Address:
2400 N BROADWAY ST
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:
37917-4627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-544-0123
Provider Business Practice Location Address Fax Number:
865-546-0392
Provider Enumeration Date:
09/25/2011