Provider First Line Business Practice Location Address:
875 UNION AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PEDIATRIC DENTISTRY
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38103-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-448-6260
Provider Business Practice Location Address Fax Number:
901-448-3817
Provider Enumeration Date:
06/18/2008