Provider First Line Business Practice Location Address:
995 S YATES RD STE 3
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:
38119-0882
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-512-8258
Provider Business Practice Location Address Fax Number:
901-252-0055
Provider Enumeration Date:
07/01/2014