Provider First Line Business Practice Location Address:
2542 RIDGEWAY RD
Provider Second Line Business Practice Location Address:
SUITE 9
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119-7422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-763-1311
Provider Business Practice Location Address Fax Number:
901-763-1355
Provider Enumeration Date:
01/25/2007