Provider First Line Business Practice Location Address:
1038 S YATES RD
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:
38119-3708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-472-4100
Provider Business Practice Location Address Fax Number:
866-436-9785
Provider Enumeration Date:
08/24/2023