Provider First Line Business Practice Location Address:
3930 S PERKINS 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:
38118-7029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-362-9880
Provider Business Practice Location Address Fax Number:
901-362-6734
Provider Enumeration Date:
02/10/2006