Provider First Line Business Practice Location Address:
845 S HIGHLAND ST
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:
38111-4254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-323-8488
Provider Business Practice Location Address Fax Number:
901-323-8489
Provider Enumeration Date:
07/13/2007