Provider First Line Business Practice Location Address:
4183 KIRBY PKWY
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:
38141-7166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-362-0540
Provider Business Practice Location Address Fax Number:
901-362-3576
Provider Enumeration Date:
12/09/2011