Provider First Line Business Practice Location Address:
3362 S 3RD 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:
38109-2944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-842-3167
Provider Business Practice Location Address Fax Number:
891-842-1873
Provider Enumeration Date:
12/14/2021