Provider First Line Business Practice Location Address:
3980 NEW COVINGTON PIKE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38128-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-383-8232
Provider Business Practice Location Address Fax Number:
901-383-8277
Provider Enumeration Date:
11/22/2005