Provider First Line Business Practice Location Address:
7705 POPLAR AVE., MEDICAL OFFICE B
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-516-6357
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/09/2020