Provider First Line Business Practice Location Address:
1707 LOCKETT PL
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:
38104-3923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-596-7645
Provider Business Practice Location Address Fax Number:
901-850-5725
Provider Enumeration Date:
11/10/2008