Provider First Line Business Practice Location Address:
578 HARRELL 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:
38112-2932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-319-8452
Provider Business Practice Location Address Fax Number:
901-255-0758
Provider Enumeration Date:
11/22/2024