Provider First Line Business Practice Location Address:
813 S NORTHSHORE DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919-7594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-584-4005
Provider Business Practice Location Address Fax Number:
865-584-5551
Provider Enumeration Date:
02/20/2013