Provider First Line Business Practice Location Address:
3810 WINCHESTER RD
Provider Second Line Business Practice Location Address:
SOUTHEAST MHC
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38118-6045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-369-1420
Provider Business Practice Location Address Fax Number:
901-369-1433
Provider Enumeration Date:
11/30/2009