Provider First Line Business Practice Location Address:
4848 LEMMON AVE
Provider Second Line Business Practice Location Address:
STE 100 LB 508
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75219-1400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-811-3555
Provider Business Practice Location Address Fax Number:
866-370-0570
Provider Enumeration Date:
08/12/2005