Provider First Line Business Practice Location Address:
4284 GETWELL RD
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:
38118-6801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-238-2742
Provider Business Practice Location Address Fax Number:
888-343-7337
Provider Enumeration Date:
02/19/2007