Provider First Line Business Practice Location Address:
4337 BALL CAMP PK
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:
37921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-546-7121
Provider Business Practice Location Address Fax Number:
865-522-5256
Provider Enumeration Date:
11/28/2006