Provider First Line Business Practice Location Address:
1227 MORRELL AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75203-3360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-942-4985
Provider Business Practice Location Address Fax Number:
214-942-4986
Provider Enumeration Date:
11/04/2009