Provider First Line Business Practice Location Address:
1210 PEABODY 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:
38104-4506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-272-0003
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2006