Provider First Line Business Practice Location Address:
1677 YORK AVE
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:
38104-5128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-274-1868
Provider Business Practice Location Address Fax Number:
901-309-8784
Provider Enumeration Date:
08/24/2006