Provider First Line Business Practice Location Address:
4038 LEMMON AVE
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75219-3736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-682-4145
Provider Business Practice Location Address Fax Number:
214-219-1120
Provider Enumeration Date:
10/16/2006