Provider First Line Business Practice Location Address:
2879 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:
38111-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-458-4580
Provider Business Practice Location Address Fax Number:
901-458-0020
Provider Enumeration Date:
06/14/2006