Provider First Line Business Practice Location Address:
4922 SPRING AVENUE
Provider Second Line Business Practice Location Address:
PRISM HEALTH NORTH TEXAS
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-421-7848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2005