Provider First Line Business Practice Location Address:
1520 UNION 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:
38174-0275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-276-2410
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2005