Provider First Line Business Practice Location Address:
79 N COOPER ST
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:
38104-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-685-5008
Provider Business Practice Location Address Fax Number:
901-685-5015
Provider Enumeration Date:
03/23/2007