Provider First Line Business Practice Location Address:
6264 POPLAR AVE STE 2
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:
38119-4759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-767-2152
Provider Business Practice Location Address Fax Number:
901-767-2155
Provider Enumeration Date:
12/22/2010