Provider First Line Business Practice Location Address: 
2014 EXETER RD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
GERMANTOWN
    Provider Business Practice Location Address State Name: 
TN
    Provider Business Practice Location Address Postal Code: 
38138-3945
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
901-624-4600
    Provider Business Practice Location Address Fax Number: 
901-757-1485
    Provider Enumeration Date: 
01/03/2007