Provider First Line Business Practice Location Address:
5518 DYER ST
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75206-5081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-360-4266
Provider Business Practice Location Address Fax Number:
214-696-6767
Provider Enumeration Date:
06/17/2006