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Individual

RUSSELL K LONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
1805 WILCREST DR APT 5, MEMPHIS, TN 38134-5017
(901) 558-8302
Mailing address
1805 WILCREST DR APT 5, MEMPHIS, TN 38134-5017
(901) 558-8302

Taxonomy

Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary

Other

Enumeration date
12/21/2024
Last updated
12/21/2024
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