Provider First Line Business Practice Location Address:
117A NEYLAND THOMPSON SPORTS CTR
Provider Second Line Business Practice Location Address:
1704 JOHNNY MAJORS DRIVE
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37996-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-974-1902
Provider Business Practice Location Address Fax Number:
865-974-1259
Provider Enumeration Date:
08/31/2006