Provider First Line Business Practice Location Address:
3650 W. WHEATLAND RD.
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75237-1259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-774-9771
Provider Business Practice Location Address Fax Number:
214-774-9762
Provider Enumeration Date:
05/23/2007