Provider First Line Business Practice Location Address:
1851 PRAIRIE VIEW DR
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-6284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-630-9331
Provider Business Practice Location Address Fax Number:
214-630-4438
Provider Enumeration Date:
07/20/2005