Provider First Line Business Practice Location Address:
3362 S 3RD ST
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:
38109-2944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-271-6671
Provider Business Practice Location Address Fax Number:
901-271-6370
Provider Enumeration Date:
06/15/2012