Provider First Line Business Practice Location Address:
3721 RIVERDALE RD
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:
38115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-334-3144
Provider Business Practice Location Address Fax Number:
901-334-3145
Provider Enumeration Date:
02/23/2013