Provider First Line Business Practice Location Address:
49 N DUNLAP ST RM 102
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:
38103-2802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-287-7496
Provider Business Practice Location Address Fax Number:
901-266-6620
Provider Enumeration Date:
03/05/2007