Provider First Line Business Practice Location Address:
6626 CENTRAL AVENUE PIKE
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:
37912-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-249-6214
Provider Business Practice Location Address Fax Number:
865-249-6503
Provider Enumeration Date:
05/03/2017