Provider First Line Business Practice Location Address:
1216 THOMAS 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:
38107-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-525-3800
Provider Business Practice Location Address Fax Number:
901-525-4040
Provider Enumeration Date:
10/25/2005