Provider First Line Business Practice Location Address:
1205 LUTTRELL ST
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:
37917-6630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-456-2494
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/16/2026