Provider First Line Business Practice Location Address:
568 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:
38105-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-527-2411
Provider Business Practice Location Address Fax Number:
901-527-2413
Provider Enumeration Date:
08/14/2008