Provider First Line Business Practice Location Address:
3150 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:
38118-7191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-520-1426
Provider Business Practice Location Address Fax Number:
901-520-1426
Provider Enumeration Date:
07/22/2026