Provider First Line Business Practice Location Address:
4740 E SHELBY DR
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38118-7406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-368-1200
Provider Business Practice Location Address Fax Number:
901-368-0600
Provider Enumeration Date:
08/23/2006