Provider First Line Business Practice Location Address:
4915 BRASHEAR ST.
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:
75210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-928-7800
Provider Business Practice Location Address Fax Number:
214-928-7803
Provider Enumeration Date:
12/03/2007