Provider First Line Business Practice Location Address:
9888 FERGUSON RD STE 101B
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:
75228-3841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-328-4389
Provider Business Practice Location Address Fax Number:
214-328-4085
Provider Enumeration Date:
07/29/2005