Provider First Line Business Practice Location Address:
2879 S MENDENHALL RD STE 1
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:
38115-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-949-1148
Provider Business Practice Location Address Fax Number:
901-260-2674
Provider Enumeration Date:
07/29/2019