Provider First Line Business Practice Location Address:
5603 FEDERAL 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:
38118-7918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-369-0866
Provider Business Practice Location Address Fax Number:
901-360-1540
Provider Enumeration Date:
08/28/2009