Provider First Line Business Practice Location Address:
12606 GREENVILLE AVE # 175
Provider Second Line Business Practice Location Address:
NORTHPOINT MEDICAL ARTS BLDG
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-866-0017
Provider Business Practice Location Address Fax Number:
972-866-0019
Provider Enumeration Date:
11/03/2005