Provider First Line Business Practice Location Address:
6223 MOUNT MORIAH ROAD EXT
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:
38115-2741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-794-3391
Provider Business Practice Location Address Fax Number:
901-794-9706
Provider Enumeration Date:
12/12/2006