Provider First Line Business Practice Location Address:
5140 OLD SUMMER 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:
38122-4403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-752-5080
Provider Business Practice Location Address Fax Number:
901-751-2299
Provider Enumeration Date:
05/20/2006