Provider First Line Business Practice Location Address:
1282 UNION 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:
38104-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-657-1370
Provider Business Practice Location Address Fax Number:
818-671-2225
Provider Enumeration Date:
11/02/2006