Provider First Line Business Practice Location Address:
1934 PENDLETON 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:
38114-4952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-744-6327
Provider Business Practice Location Address Fax Number:
901-745-2749
Provider Enumeration Date:
10/28/2015