Provider First Line Business Practice Location Address:
2509 SUMMER 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:
38112-2627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-323-5438
Provider Business Practice Location Address Fax Number:
901-323-5559
Provider Enumeration Date:
06/21/2005