Provider First Line Business Practice Location Address:
200 FORT SANDERS WEST BLVD
Provider Second Line Business Practice Location Address:
MEDICAL OFFICE BLDG #1 SUITE 304
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37922-3357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-531-8848
Provider Business Practice Location Address Fax Number:
865-693-1398
Provider Enumeration Date:
11/06/2006