Provider First Line Business Practice Location Address:
2528 N FITZHUGH AVE
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:
75204-3387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-253-0000
Provider Business Practice Location Address Fax Number:
214-823-2550
Provider Enumeration Date:
02/05/2014