Provider First Line Business Practice Location Address:
5323 HARRY HINES BLVD
Provider Second Line Business Practice Location Address:
PSYCHOLOGY DIVISION, UT SOUTHWESTERN MED CTR
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75390-9044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-648-5270
Provider Business Practice Location Address Fax Number:
214-648-4660
Provider Enumeration Date:
04/05/2006