Provider First Line Business Practice Location Address:
10 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
PLAZA 3, SUITE 202
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75234-7840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-661-9197
Provider Business Practice Location Address Fax Number:
972-692-7153
Provider Enumeration Date:
11/01/2006