Provider First Line Business Practice Location Address:
210 N AUBURNDALE ST
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:
38112-5308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-606-7305
Provider Business Practice Location Address Fax Number:
901-205-0777
Provider Enumeration Date:
03/06/2009