Provider First Line Business Practice Location Address: 
2201 INWOOD DR.
    Provider Second Line Business Practice Location Address: 
SIMMONS COMPREHENSIVE CANCER CENTER
    Provider Business Practice Location Address City Name: 
DALLAS
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
75390-9161
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
214-645-2563
    Provider Business Practice Location Address Fax Number: 
214-645-2562
    Provider Enumeration Date: 
05/29/2012