Provider First Line Business Practice Location Address:
2144 MONROE AVE
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:
38104-4229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-274-9046
Provider Business Practice Location Address Fax Number:
901-272-7360
Provider Enumeration Date:
06/20/2005