Provider First Line Business Practice Location Address:
5959 HARRY HINES BLVD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-879-8490
Provider Business Practice Location Address Fax Number:
214-879-8496
Provider Enumeration Date:
11/30/2005