Provider First Line Business Practice Location Address:
7705 POPLAR AVENUE, SUITE 240
Provider Second Line Business Practice Location Address:
PROFESSIONAL BLDG. B
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-791-9800
Provider Business Practice Location Address Fax Number:
901-791-9801
Provider Enumeration Date:
06/13/2006