Provider First Line Business Practice Location Address:
2400 S LANCASTER RD
Provider Second Line Business Practice Location Address:
DOMICILIARY 181
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75216-2530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-857-1133
Provider Business Practice Location Address Fax Number:
214-857-1123
Provider Enumeration Date:
06/09/2006