Provider First Line Business Practice Location Address:
3329 KIRBY PKWY STE 1
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:
38115-3816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-365-6004
Provider Business Practice Location Address Fax Number:
901-365-9956
Provider Enumeration Date:
12/21/2010