Provider First Line Business Practice Location Address:
1195 POPLAR 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:
38105-4807
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-722-8445
Provider Business Practice Location Address Fax Number:
901-722-2425
Provider Enumeration Date:
10/12/2005