Provider First Line Business Practice Location Address:
1169 JEFFERSON 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:
38104-7217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-425-1880
Provider Business Practice Location Address Fax Number:
901-725-5768
Provider Enumeration Date:
01/10/2007