Provider First Line Business Practice Location Address:
612 S COOPER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104-5352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-272-2822
Provider Business Practice Location Address Fax Number:
901-272-2823
Provider Enumeration Date:
01/08/2007