Provider First Line Business Practice Location Address:
2883 S MENDENHALL RD STE 3-4
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:
38115-1748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-347-2368
Provider Business Practice Location Address Fax Number:
901-421-5622
Provider Enumeration Date:
09/14/2005