Provider First Line Business Practice Location Address:
3795 OLD GETWELL 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:
38118-6031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-367-1907
Provider Business Practice Location Address Fax Number:
901-367-1596
Provider Enumeration Date:
09/15/2009