Provider First Line Business Practice Location Address:
2900 KIRBY RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119-8221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-757-0655
Provider Business Practice Location Address Fax Number:
901-757-1608
Provider Enumeration Date:
01/25/2012