Provider First Line Business Practice Location Address:
1000 HAYNES 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:
38114-3374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-515-5257
Provider Business Practice Location Address Fax Number:
901-544-7602
Provider Enumeration Date:
11/30/2006