Provider First Line Business Practice Location Address:
4137 KIRBY PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-794-3397
Provider Business Practice Location Address Fax Number:
901-794-3398
Provider Enumeration Date:
12/15/2006