Provider First Line Business Practice Location Address:
2001 LAUREL AVE
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-1865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-524-3131
Provider Business Practice Location Address Fax Number:
865-212-6323
Provider Enumeration Date:
06/22/2005