Provider First Line Business Practice Location Address:
350 N HUMPHREYS BLVD
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:
38120-2177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-227-0497
Provider Business Practice Location Address Fax Number:
901-227-0499
Provider Enumeration Date:
07/07/2006