Provider First Line Business Practice Location Address:
1021 IKEA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND PRAIRIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75052-0043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-812-0293
Provider Business Practice Location Address Fax Number:
972-730-9237
Provider Enumeration Date:
02/05/2026