Provider First Line Business Practice Location Address:
538 W 5TH AVE
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:
37917-7109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-525-2104
Provider Business Practice Location Address Fax Number:
865-525-2212
Provider Enumeration Date:
02/11/2009