Provider First Line Business Practice Location Address: 
9323 GARLAND RD
    Provider Second Line Business Practice Location Address: 
SUITE 307
    Provider Business Practice Location Address City Name: 
DALLAS
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
75218-3600
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
214-321-2400
    Provider Business Practice Location Address Fax Number: 
214-321-3902
    Provider Enumeration Date: 
08/22/2006