Provider First Line Business Practice Location Address:
3310 LIVE OAK ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75204-6153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-827-1305
Provider Business Practice Location Address Fax Number:
214-827-4277
Provider Enumeration Date:
10/13/2006