Provider First Line Business Practice Location Address:
2750 MOUNT MORIAH PKWY
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:
38115-2063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-766-6742
Provider Business Practice Location Address Fax Number:
901-766-6743
Provider Enumeration Date:
07/18/2006