Provider First Line Business Practice Location Address:
1715 KIRBY PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-309-2832
Provider Business Practice Location Address Fax Number:
901-309-2833
Provider Enumeration Date:
01/30/2007