Provider First Line Business Practice Location Address:
4131 KIRBY PKWY STE 1
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:
38115-6500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-368-6883
Provider Business Practice Location Address Fax Number:
901-368-1803
Provider Enumeration Date:
11/14/2006