Provider First Line Business Practice Location Address:
2389 LAMAR AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38114-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-744-0888
Provider Business Practice Location Address Fax Number:
901-744-0888
Provider Enumeration Date:
03/23/2007