Provider First Line Business Practice Location Address:
2900 KIRBY RD
Provider Second Line Business Practice Location Address:
SUITE #4
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-363-2001
Provider Business Practice Location Address Fax Number:
901-367-9355
Provider Enumeration Date:
10/23/2006