Provider First Line Business Practice Location Address:
3180 MILLINGTON 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:
38127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-362-4171
Provider Business Practice Location Address Fax Number:
901-362-4172
Provider Enumeration Date:
11/30/2006