Provider First Line Business Practice Location Address:
3485 DENVER ST
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:
38127-5673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-354-1806
Provider Business Practice Location Address Fax Number:
901-354-1862
Provider Enumeration Date:
02/23/2026