Provider First Line Business Practice Location Address:
860 W HOLMES RD
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:
38109-6940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-948-4809
Provider Business Practice Location Address Fax Number:
901-620-0191
Provider Enumeration Date:
01/28/2008