Provider First Line Business Practice Location Address:
1201 W CAMP WISDOM RD
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:
75232-3446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-376-2709
Provider Business Practice Location Address Fax Number:
214-376-3074
Provider Enumeration Date:
11/01/2006