Provider First Line Business Practice Location Address:
2500 MOUNT MORIAH RD
Provider Second Line Business Practice Location Address:
BUILDING H SUITE 200
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38115-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-672-7289
Provider Business Practice Location Address Fax Number:
901-672-7356
Provider Enumeration Date:
12/14/2007