Provider First Line Business Practice Location Address:
1505 S PERKINS RD
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:
38117-6530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-682-1006
Provider Business Practice Location Address Fax Number:
901-682-5775
Provider Enumeration Date:
06/01/2005