Provider First Line Business Practice Location Address:
4432 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:
75215-4349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-565-9898
Provider Business Practice Location Address Fax Number:
212-565-9899
Provider Enumeration Date:
03/22/2007