Provider First Line Business Practice Location Address:
766 S WHITE STATION RD
Provider Second Line Business Practice Location Address:
2A
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38117-4579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-761-9178
Provider Business Practice Location Address Fax Number:
901-761-9167
Provider Enumeration Date:
01/09/2007