Provider First Line Business Practice Location Address:
2049 E SHELBY DR
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:
38116-7639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-348-1931
Provider Business Practice Location Address Fax Number:
901-348-8401
Provider Enumeration Date:
05/11/2010