Provider First Line Business Practice Location Address:
6242 POPLAR AVE STE 1
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:
38119-4730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-403-7147
Provider Business Practice Location Address Fax Number:
901-842-4330
Provider Enumeration Date:
07/30/2024