Provider First Line Business Practice Location Address:
5498 POPLUR AVE
Provider Second Line Business Practice Location Address:
SUITE C1
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-682-9631
Provider Business Practice Location Address Fax Number:
901-682-9631
Provider Enumeration Date:
10/02/2006