Provider First Line Business Practice Location Address:
2909 S HAMPTON RD
Provider Second Line Business Practice Location Address:
SUITE F- 122, LOCK BOX 29
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75224-3000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-339-9350
Provider Business Practice Location Address Fax Number:
214-331-9164
Provider Enumeration Date:
03/17/2008