Provider First Line Business Practice Location Address:
6240 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:
38141-7735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-654-3179
Provider Business Practice Location Address Fax Number:
901-654-3263
Provider Enumeration Date:
01/25/2012