Provider First Line Business Practice Location Address: 
5000 W SLAUGHTER LN
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
AUSTIN
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
78749-3997
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
512-654-4000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
03/25/2015