Provider First Line Business Practice Location Address:
2150 COVINGTON PIKE
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:
38128-6907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-382-1616
Provider Business Practice Location Address Fax Number:
901-385-2857
Provider Enumeration Date:
07/16/2006