Provider First Line Business Practice Location Address:
992 LEWIS 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:
38107-2817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-559-8098
Provider Business Practice Location Address Fax Number:
870-559-8098
Provider Enumeration Date:
02/17/2026