Provider First Line Business Practice Location Address:
1407 UNION 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:
38104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-800-4645
Provider Business Practice Location Address Fax Number:
901-729-6377
Provider Enumeration Date:
09/04/2007