Provider First Line Business Practice Location Address:
5939 HARRY HINES BLVD
Provider Second Line Business Practice Location Address:
SUITE 400, MAIL CODE 9191
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75390-9191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-645-2422
Provider Business Practice Location Address Fax Number:
214-645-2420
Provider Enumeration Date:
03/03/2006