Provider First Line Business Practice Location Address:
5317 CLINTON HWY
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:
37912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-689-4113
Provider Business Practice Location Address Fax Number:
865-689-5991
Provider Enumeration Date:
01/22/2008