Provider First Line Business Practice Location Address:
2600 POPLAR AVE STE 6A
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:
38112-3854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-323-9441
Provider Business Practice Location Address Fax Number:
901-323-9442
Provider Enumeration Date:
07/24/2007