Provider First Line Business Practice Location Address:
6464 E NORTHWEST HWY STE 331
Provider Second Line Business Practice Location Address:
MEDALLION CENTER - BACKMENDERS
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75214-7800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-232-6363
Provider Business Practice Location Address Fax Number:
469-232-2225
Provider Enumeration Date:
05/11/2008