Provider First Line Business Practice Location Address:
3481 AUSTIN PEAY HWY
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:
38128-3801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-701-2570
Provider Business Practice Location Address Fax Number:
901-701-2576
Provider Enumeration Date:
02/22/2016