Provider First Line Business Practice Location Address:
2506 MOUNT MORIAH RD
Provider Second Line Business Practice Location Address:
BLDG. B. STE. 413
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38115-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-217-1947
Provider Business Practice Location Address Fax Number:
901-842-9391
Provider Enumeration Date:
01/25/2009