Provider First Line Business Practice Location Address:
1218 N BISHOP 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:
75208-4117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-942-9205
Provider Business Practice Location Address Fax Number:
214-946-8625
Provider Enumeration Date:
02/21/2007