Provider First Line Business Practice Location Address:
124 S HUMES 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:
38111-1918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-414-3453
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2020