Provider First Line Business Practice Location Address:
2 AUCTION 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:
38105-1502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-544-3912
Provider Business Practice Location Address Fax Number:
901-544-3915
Provider Enumeration Date:
12/15/2005