Provider First Line Business Practice Location Address:
5425 MEADOWICK 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:
38115-3643
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-725-6911
Provider Business Practice Location Address Fax Number:
901-725-4885
Provider Enumeration Date:
12/14/2009