Provider First Line Business Practice Location Address:
2506 MOUNT MORIAH RD
Provider Second Line Business Practice Location Address:
SUITE B415
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38115-1511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-238-4071
Provider Business Practice Location Address Fax Number:
901-791-2572
Provider Enumeration Date:
10/08/2009