Provider First Line Business Practice Location Address:
1000 S COOPER 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:
38104-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-844-4357
Provider Business Practice Location Address Fax Number:
901-844-4357
Provider Enumeration Date:
05/18/2010