Provider First Line Business Practice Location Address:
251 S CLAYBROOK ST
Provider Second Line Business Practice Location Address:
A212
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104-3539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-516-8255
Provider Business Practice Location Address Fax Number:
901-516-8254
Provider Enumeration Date:
11/03/2009