Provider First Line Business Practice Location Address:
1027 SOUTH YATES ROAD
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:
38119-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-682-6136
Provider Business Practice Location Address Fax Number:
901-682-7136
Provider Enumeration Date:
12/13/2006