Provider First Line Business Practice Location Address:
2508 OAK LAWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75219-4018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-221-8181
Provider Business Practice Location Address Fax Number:
214-221-8282
Provider Enumeration Date:
11/14/2005