Provider First Line Business Practice Location Address: 
5080 SPECTRUM DR
    Provider Second Line Business Practice Location Address: 
SUITE 1200 WEST
    Provider Business Practice Location Address City Name: 
ADDISON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
75001-4648
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
972-364-8000
    Provider Business Practice Location Address Fax Number: 
214-775-4502
    Provider Enumeration Date: 
02/12/2007