Provider First Line Business Practice Location Address:
6166 E SHELBY DR
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:
38141-7701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-236-7619
Provider Business Practice Location Address Fax Number:
901-310-4658
Provider Enumeration Date:
06/12/2023