Provider First Line Business Practice Location Address:
4849 W LAWTHER DR
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:
75214-1879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-827-8080
Provider Business Practice Location Address Fax Number:
214-370-2830
Provider Enumeration Date:
09/12/2005