Provider First Line Business Practice Location Address:
4115 S PLAZA 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:
38116-6334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-398-6388
Provider Business Practice Location Address Fax Number:
901-398-2557
Provider Enumeration Date:
08/31/2006