Provider First Line Business Practice Location Address:
4552 LONGTREE 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:
38128-7447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-245-8022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2026