Provider First Line Business Practice Location Address:
4100 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:
38128-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-213-5400
Provider Business Practice Location Address Fax Number:
901-213-5405
Provider Enumeration Date:
02/16/2006