Provider First Line Business Practice Location Address:
2835 KIRBY RD
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:
38119-8209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-353-1387
Provider Business Practice Location Address Fax Number:
901-353-5974
Provider Enumeration Date:
08/27/2010