Provider First Line Business Practice Location Address:
690 S MENDENHALL 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:
38117-5213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-440-8339
Provider Business Practice Location Address Fax Number:
901-759-4119
Provider Enumeration Date:
04/01/2011