Provider First Line Business Practice Location Address:
142 FAIRBANKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK RIDGE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37830-7000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-888-5431
Provider Business Practice Location Address Fax Number:
865-888-5432
Provider Enumeration Date:
12/17/2012