Provider First Line Business Practice Location Address:
205 E MOODY AVE
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:
37920-4203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-579-9585
Provider Business Practice Location Address Fax Number:
865-579-9557
Provider Enumeration Date:
03/06/2007