Provider First Line Business Practice Location Address:
6485 POPLAR AVE
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:
38119-4864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-767-4014
Provider Business Practice Location Address Fax Number:
901-767-1695
Provider Enumeration Date:
03/14/2006