Provider First Line Business Practice Location Address:
2502 MOUNT MORIAH RD STE A-148
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:
38115-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-546-7660
Provider Business Practice Location Address Fax Number:
901-546-7662
Provider Enumeration Date:
09/28/2006