Provider First Line Business Practice Location Address:
3216 PARK 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:
38111-3046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-327-0003
Provider Business Practice Location Address Fax Number:
901-327-1894
Provider Enumeration Date:
12/22/2006