Provider First Line Business Practice Location Address:
200 FORT SANDERS WEST BLVD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-691-1121
Provider Business Practice Location Address Fax Number:
865-691-9866
Provider Enumeration Date:
10/05/2006