Provider First Line Business Practice Location Address:
370 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:
38120-2432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-694-4750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2024