Provider First Line Business Practice Location Address:
2579 DOUGLASS AVE
Provider Second Line Business Practice Location Address:
SOUTHEAST MENTAL HEALTH CENTER
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38114-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-369-1480
Provider Business Practice Location Address Fax Number:
901-312-7572
Provider Enumeration Date:
07/11/2005