Provider First Line Business Practice Location Address:
7705 POPLAR AVENUE
Provider Second Line Business Practice Location Address:
SUITE 310B THE SHAPPLEY CLINIC
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-759-0101
Provider Business Practice Location Address Fax Number:
901-759-1588
Provider Enumeration Date:
11/07/2006