Provider First Line Business Practice Location Address:
540 S MENDENHALL RD STE 16
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:
38117-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-683-8843
Provider Business Practice Location Address Fax Number:
901-680-5621
Provider Enumeration Date:
07/10/2006