Provider First Line Business Practice Location Address:
4500 LANCASTER 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:
75216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-742-8283
Provider Business Practice Location Address Fax Number:
214-462-4609
Provider Enumeration Date:
09/05/2006