Provider First Line Business Practice Location Address: 
12222 MERIT DR STE 600
    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: 
75251-3294
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
972-715-5000
    Provider Business Practice Location Address Fax Number: 
972-715-9976
    Provider Enumeration Date: 
07/07/2011