Provider First Line Business Practice Location Address:
4646 POPLAR AVE
Provider Second Line Business Practice Location Address:
STE 206
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-684-2272
Provider Business Practice Location Address Fax Number:
901-309-8784
Provider Enumeration Date:
08/19/2006