Provider First Line Business Practice Location Address:
2264 S LAUDERDALE 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:
38106-7566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-774-4448
Provider Business Practice Location Address Fax Number:
901-248-6897
Provider Enumeration Date:
07/29/2010