Provider First Line Business Practice Location Address:
4646 POPLAR AVE
Provider Second Line Business Practice Location Address:
#326
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38117-4426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-496-8149
Provider Business Practice Location Address Fax Number:
901-414-1711
Provider Enumeration Date:
09/11/2006