Provider First Line Business Practice Location Address:
3725 LEMMON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75219-4332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-219-3393
Provider Business Practice Location Address Fax Number:
214-443-1862
Provider Enumeration Date:
01/12/2007