Provider First Line Business Practice Location Address:
6972 APPLING FARMS PKWY
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38133-4725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-818-0911
Provider Business Practice Location Address Fax Number:
901-377-1599
Provider Enumeration Date:
06/21/2005