Provider First Line Business Practice Location Address:
1359 POPLAR 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:
38104-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-276-5491
Provider Business Practice Location Address Fax Number:
901-276-0280
Provider Enumeration Date:
10/14/2011