Provider First Line Business Practice Location Address:
3624 AUSTIN PEAY HWY
Provider Second Line Business Practice Location Address:
SUITE6
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38128-3776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-386-5031
Provider Business Practice Location Address Fax Number:
901-386-0338
Provider Enumeration Date:
03/26/2007