Provider First Line Business Practice Location Address:
1513 N 2ND ST
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:
38107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-272-2494
Provider Business Practice Location Address Fax Number:
901-272-1387
Provider Enumeration Date:
04/12/2006