Provider First Line Business Practice Location Address:
6077 E PRIMACY PKWY STE 102
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:
38119-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-380-4404
Provider Business Practice Location Address Fax Number:
901-380-1340
Provider Enumeration Date:
01/15/2008