Provider First Line Business Practice Location Address:
1719 KIRBY PKWY
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:
38120-4367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-685-1994
Provider Business Practice Location Address Fax Number:
901-685-1997
Provider Enumeration Date:
05/20/2006