Provider First Line Business Practice Location Address:
4500 S LANCASTER
Provider Second Line Business Practice Location Address:
VA MEDICAL CENTER
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-857-1744
Provider Business Practice Location Address Fax Number:
214-857-1719
Provider Enumeration Date:
08/31/2006