Provider First Line Business Practice Location Address:
3113 LAKEMOOR VIEW RD
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:
37920-2868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-737-2968
Provider Business Practice Location Address Fax Number:
865-409-5726
Provider Enumeration Date:
12/18/2023