Provider First Line Business Practice Location Address:
1301 PRIMACY PKWY
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:
38119-0213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-866-8630
Provider Business Practice Location Address Fax Number:
901-302-2630
Provider Enumeration Date:
10/11/2021