Provider First Line Business Practice Location Address:
3420 W ILLINOIS AVE
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75211-8722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-331-4700
Provider Business Practice Location Address Fax Number:
214-331-4712
Provider Enumeration Date:
10/15/2009