Provider First Line Business Practice Location Address:
1687 N SHELBY OAKS DR
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38134-7421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-379-0096
Provider Business Practice Location Address Fax Number:
901-379-0018
Provider Enumeration Date:
09/29/2006