Provider First Line Business Practice Location Address:
5000 MALCOLM X BLVD
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:
75215-4741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-749-5929
Provider Business Practice Location Address Fax Number:
972-749-5948
Provider Enumeration Date:
05/17/2007