Provider First Line Business Practice Location Address:
2670 UNION AVE EXTENDED
Provider Second Line Business Practice Location Address:
STE 1224
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38112-4416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-458-0570
Provider Business Practice Location Address Fax Number:
901-458-5929
Provider Enumeration Date:
12/15/2009