Provider First Line Business Practice Location Address:
3423 SUMMER AVE
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:
38122-3609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-452-2189
Provider Business Practice Location Address Fax Number:
901-452-2167
Provider Enumeration Date:
09/26/2005