Provider First Line Business Practice Location Address: 
6005 PARK AVE
    Provider Second Line Business Practice Location Address: 
SUITE 700
    Provider Business Practice Location Address City Name: 
MEMPHIS
    Provider Business Practice Location Address State Name: 
TN
    Provider Business Practice Location Address Postal Code: 
38119-5202
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
901-527-3391
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/05/2006