Provider First Line Business Practice Location Address:
776 MOUNT MORIAH RD
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:
38117-5350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-683-5239
Provider Business Practice Location Address Fax Number:
901-683-7441
Provider Enumeration Date:
07/26/2006