Provider First Line Business Practice Location Address:
2430 POPLAR AVE
Provider Second Line Business Practice Location Address:
C/O FAMILY SERVICES OF THE MID-SOUTH
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38112-3246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-324-3647
Provider Business Practice Location Address Fax Number:
901-324-9114
Provider Enumeration Date:
01/02/2008