Provider First Line Business Practice Location Address:
6800 POPLAR AVE
Provider Second Line Business Practice Location Address:
STE 105
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-756-0005
Provider Business Practice Location Address Fax Number:
901-756-7334
Provider Enumeration Date:
04/16/2007