Provider First Line Business Practice Location Address:
2619 S. LANCASTER RD
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:
75216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-376-7388
Provider Business Practice Location Address Fax Number:
214-376-7899
Provider Enumeration Date:
07/15/2013