Provider First Line Business Practice Location Address:
433 W 12TH ST
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:
75208-6507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-943-7799
Provider Business Practice Location Address Fax Number:
214-975-2793
Provider Enumeration Date:
10/16/2006