Provider First Line Business Practice Location Address:
232 S HIGHLAND ST
Provider Second Line Business Practice Location Address:
APT 201
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38111-4567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-438-8141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2008