Provider First Line Business Practice Location Address: 
5323 HARRY HINES BLVD
    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: 
75390-1559
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
214-456-7000
    Provider Business Practice Location Address Fax Number: 
214-456-8132
    Provider Enumeration Date: 
07/06/2015