Provider First Line Business Practice Location Address:
2150 COVINGTON PIKE STE A
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:
38128-6907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-381-9483
Provider Business Practice Location Address Fax Number:
901-382-5410
Provider Enumeration Date:
07/19/2006