Provider First Line Business Practice Location Address:
4500 LANCASTER
Provider Second Line Business Practice Location Address:
BLDG 7, R# 119A
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:
214-372-5300
Provider Business Practice Location Address Fax Number:
214-372-5020
Provider Enumeration Date:
09/20/2006