Provider First Line Business Practice Location Address: 
5201 HARRY HINES BLVD - SURGICAL SERVICES
    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: 
75266-0599
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
214-590-8640
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/08/2008