Provider First Line Business Practice Location Address:
3585 AUSTIN PEAY HWY SUITE #112
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-229-6565
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2007