Provider First Line Business Practice Location Address:
3720 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:
37917-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-315-8353
Provider Business Practice Location Address Fax Number:
865-314-8364
Provider Enumeration Date:
09/28/2016