Provider First Line Business Practice Location Address:
2001 LAUREL AVE
Provider Second Line Business Practice Location Address:
SUITE 402 NEWLAND PROFESSIONAL BLDG.
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-632-5577
Provider Business Practice Location Address Fax Number:
865-632-5584
Provider Enumeration Date:
01/24/2007