Provider First Line Business Practice Location Address:
5812 STRAWBERRY PLAINS PIKE
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:
37914-9528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-356-5148
Provider Business Practice Location Address Fax Number:
865-769-0801
Provider Enumeration Date:
09/14/2017