Provider First Line Business Practice Location Address:
3950 AUSTIN PEAY HWY
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:
38128-2516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-223-7294
Provider Business Practice Location Address Fax Number:
901-380-1276
Provider Enumeration Date:
08/18/2010