Provider First Line Business Practice Location Address:
1160 CHEMBERRY PL
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:
38120-4073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-482-4238
Provider Business Practice Location Address Fax Number:
901-482-4238
Provider Enumeration Date:
04/27/2006