Provider First Line Business Practice Location Address:
1212 E SHELBY DR
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:
38116-7124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-346-3336
Provider Business Practice Location Address Fax Number:
901-346-6613
Provider Enumeration Date:
06/18/2011