Provider First Line Business Practice Location Address: 
431 PARK VILLAGE RD STE 105
    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: 
37923-3806
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
865-730-4200
    Provider Business Practice Location Address Fax Number: 
865-730-4201
    Provider Enumeration Date: 
02/08/2007