Provider First Line Business Practice Location Address:
2506 MOUNT MORIAH RD
Provider Second Line Business Practice Location Address:
SUITE B-412
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38115-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-461-0040
Provider Business Practice Location Address Fax Number:
901-363-8029
Provider Enumeration Date:
03/30/2007