Provider First Line Business Practice Location Address:
4255 AMON CARTER BLVD
Provider Second Line Business Practice Location Address:
AMERICAN AIRLINES MEDICAL DEPT.
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76155-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-963-1295
Provider Business Practice Location Address Fax Number:
817-963-6378
Provider Enumeration Date:
06/18/2007