Provider First Line Business Practice Location Address:
1076 CHAMBLISS 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:
38116-6381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-396-8470
Provider Business Practice Location Address Fax Number:
901-398-0271
Provider Enumeration Date:
10/26/2005