Provider First Line Business Practice Location Address:
3445 POPLAR AVE STE 13
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:
38111-4667
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-276-2357
Provider Business Practice Location Address Fax Number:
901-276-2359
Provider Enumeration Date:
11/30/2006