Provider First Line Business Practice Location Address:
9208 ELAM RD
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75217-4178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-398-3251
Provider Business Practice Location Address Fax Number:
214-398-7251
Provider Enumeration Date:
08/09/2005