Provider First Line Business Practice Location Address:
5148 ELMORE RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38134-5634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-384-0888
Provider Business Practice Location Address Fax Number:
901-384-0886
Provider Enumeration Date:
05/23/2007