Provider First Line Business Practice Location Address:
2245 S LAUDERDALE ST
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:
38106-7517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-948-5558
Provider Business Practice Location Address Fax Number:
901-774-9031
Provider Enumeration Date:
02/06/2007