Provider First Line Business Practice Location Address:
K-MART PHARMACY #7460
Provider Second Line Business Practice Location Address:
6906 MANARDVILLE PIKE NE
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-922-7443
Provider Business Practice Location Address Fax Number:
865-922-1604
Provider Enumeration Date:
05/18/2007