Provider First Line Business Practice Location Address: 
6520 MEMPHIS ARLINGTON RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
BARTLETT
    Provider Business Practice Location Address State Name: 
TN
    Provider Business Practice Location Address Postal Code: 
38135-2402
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
901-388-4331
    Provider Business Practice Location Address Fax Number: 
901-388-4250
    Provider Enumeration Date: 
04/13/2020