Provider First Line Business Practice Location Address:
1417 MONROE AVE
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:
38104-3634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-296-9400
Provider Business Practice Location Address Fax Number:
901-272-0820
Provider Enumeration Date:
01/12/2010