Provider First Line Business Practice Location Address:
1714 SOUTHWALL 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:
38114-5634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-461-5720
Provider Business Practice Location Address Fax Number:
901-745-1082
Provider Enumeration Date:
10/25/2008