Provider First Line Business Practice Location Address: 
621 N HALL ST
    Provider Second Line Business Practice Location Address: 
SUITE 500
    Provider Business Practice Location Address City Name: 
DALLAS
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
75226-1339
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
214-841-2000
    Provider Business Practice Location Address Fax Number: 
214-841-2015
    Provider Enumeration Date: 
03/01/2006