Provider First Line Business Practice Location Address:
9440 GARLAND RD
Provider Second Line Business Practice Location Address:
STE. 198
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75218-5003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-613-2122
Provider Business Practice Location Address Fax Number:
214-613-2127
Provider Enumeration Date:
12/06/2005