Provider First Line Business Practice Location Address:
1428 MONROE AVE
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:
38104-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-272-2667
Provider Business Practice Location Address Fax Number:
901-272-2932
Provider Enumeration Date:
07/23/2006