Provider First Line Business Practice Location Address:
1500 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
JOHN PETER SMITH HOSPITAL ED,
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-7339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-825-9222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2012