Provider First Line Business Practice Location Address:
2400 JORDAN 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:
75215-3737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-280-7474
Provider Business Practice Location Address Fax Number:
214-421-3835
Provider Enumeration Date:
03/01/2008