Provider First Line Business Practice Location Address:
6099 MOUNT MORIAH ROAD EXT STE 9A
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:
38115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-313-0044
Provider Business Practice Location Address Fax Number:
901-255-2567
Provider Enumeration Date:
04/16/2013