Provider First Line Business Practice Location Address:
2960B OLD AUSTIN PEAY HWY
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:
38128-5631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-372-9898
Provider Business Practice Location Address Fax Number:
901-373-9298
Provider Enumeration Date:
11/05/2013