Provider First Line Business Practice Location Address:
825 RIDGE LAKE BLVD
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:
38120-9411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-685-6150
Provider Business Practice Location Address Fax Number:
901-685-6454
Provider Enumeration Date:
02/27/2007