Provider First Line Business Practice Location Address:
1656 LAMAR AVE
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:
38114-1642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-473-9221
Provider Business Practice Location Address Fax Number:
901-405-1319
Provider Enumeration Date:
03/12/2007