Provider First Line Business Practice Location Address:
6244 POPLAR 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:
38119-4732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-682-4682
Provider Business Practice Location Address Fax Number:
901-507-4523
Provider Enumeration Date:
11/02/2006