Provider First Line Business Practice Location Address:
1936 AMELIA CT
Provider Second Line Business Practice Location Address:
SENIOR HOUSE CALLS- SUPPORT BLDG C
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-7706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-590-0409
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2005