Provider First Line Business Practice Location Address:
3314 POPLAR AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38111-4681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-324-3189
Provider Business Practice Location Address Fax Number:
901-324-2851
Provider Enumeration Date:
10/18/2006