Provider First Line Business Practice Location Address:
2829 LAMAR 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:
38114-5016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-744-4990
Provider Business Practice Location Address Fax Number:
901-744-8366
Provider Enumeration Date:
08/27/2010