Provider First Line Business Practice Location Address:
3785 OLD EGYPT CENTRAL
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-373-9346
Provider Business Practice Location Address Fax Number:
901-312-9906
Provider Enumeration Date:
08/21/2008