Provider First Line Business Practice Location Address:
2729 S LANCASTER RD
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:
75216-3114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-371-3131
Provider Business Practice Location Address Fax Number:
214-371-3140
Provider Enumeration Date:
02/14/2011