Provider First Line Business Practice Location Address:
1717 N GARRETT 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:
75206-7514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-827-6880
Provider Business Practice Location Address Fax Number:
214-827-0520
Provider Enumeration Date:
08/17/2006