Provider First Line Business Practice Location Address:
4520 ELVIS PRESLEY BLVD
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:
38116-7108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-332-8080
Provider Business Practice Location Address Fax Number:
901-332-8081
Provider Enumeration Date:
09/19/2008