Provider First Line Business Practice Location Address:
5340 POPLAR AVE
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:
38119-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-682-4007
Provider Business Practice Location Address Fax Number:
901-683-4124
Provider Enumeration Date:
07/27/2006