Provider First Line Business Practice Location Address:
ORAL AND MAXILLOFACIAL SURGERY
Provider Second Line Business Practice Location Address:
5939 HARRY HINES BLVD, #210
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75390-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-645-3999
Provider Business Practice Location Address Fax Number:
214-645-3989
Provider Enumeration Date:
06/22/2005