Provider First Line Business Practice Location Address:
UT COLLEGE OF MEDICINE 920 MADISON AVENUE
Provider Second Line Business Practice Location Address:
SUITE C50
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38163-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-448-5364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2008