Provider First Line Business Practice Location Address:
UT SOUTHWESTERN MEDICAL CTR
Provider Second Line Business Practice Location Address:
GASTRO DIVISION MC 9063, 5323 HARRY HINES BLVD
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-844-0146
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/18/2007