Provider First Line Business Practice Location Address:
4500 SOUTH LANCASTER RD
Provider Second Line Business Practice Location Address:
GENERAL INTERNAL MEDICINE 111E
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75216-7167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-857-1577
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2006