Provider First Line Business Practice Location Address:
756 CARPENTER 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:
38112-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-430-6813
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2025