Provider First Line Business Practice Location Address:
2800 ROUTH ST
Provider Second Line Business Practice Location Address:
SUITE 255
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75201-1415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-740-1186
Provider Business Practice Location Address Fax Number:
214-740-9781
Provider Enumeration Date:
09/06/2007