Provider First Line Business Practice Location Address:
4646 POPLAR AVE
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38117-4426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-405-0990
Provider Business Practice Location Address Fax Number:
901-405-0993
Provider Enumeration Date:
07/24/2006