Provider First Line Business Practice Location Address:
5253 HARRY HINES BLVD
Provider Second Line Business Practice Location Address:
UT SOUTHWESTERN MEDICAL CENTER
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-7708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-723-3219
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/06/2016