Provider First Line Business Practice Location Address:
2823 S HOUSTON LEVEE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38139-6912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-457-2440
Provider Business Practice Location Address Fax Number:
901-853-3285
Provider Enumeration Date:
06/18/2006