Provider First Line Business Practice Location Address:
6150 POPLAR AVE
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119-4784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-683-0210
Provider Business Practice Location Address Fax Number:
901-683-0197
Provider Enumeration Date:
07/27/2005