Provider First Line Business Practice Location Address:
6063 MOUNT MORIAH ROAD EXT
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38115-2644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-531-8800
Provider Business Practice Location Address Fax Number:
901-531-8801
Provider Enumeration Date:
07/20/2007