Provider First Line Business Practice Location Address:
3330 S LANCASTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75216-4531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-371-6639
Provider Business Practice Location Address Fax Number:
214-372-6199
Provider Enumeration Date:
05/31/2005