Provider First Line Business Practice Location Address:
3481 AUSTIN PEAY HWY
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:
38128-3801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-260-8500
Provider Business Practice Location Address Fax Number:
901-260-8598
Provider Enumeration Date:
06/15/2009