Provider First Line Business Practice Location Address:
3468 PLAZA 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:
38111-4614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-452-1103
Provider Business Practice Location Address Fax Number:
901-452-6641
Provider Enumeration Date:
04/07/2008