Provider First Line Business Practice Location Address:
8100 JOHN W. CARPENTER FREEWAY
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75247-4721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-677-4895
Provider Business Practice Location Address Fax Number:
972-677-4896
Provider Enumeration Date:
12/23/2009