Provider First Line Business Practice Location Address:
3634 AUSTIN PEAY HWY
Provider Second Line Business Practice Location Address:
SUITE #100
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38128-3798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-377-7511
Provider Business Practice Location Address Fax Number:
901-377-6455
Provider Enumeration Date:
02/20/2007