Provider First Line Business Practice Location Address:
502 WEST TENTH 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-948-9486
Provider Business Practice Location Address Fax Number:
972-283-0282
Provider Enumeration Date:
10/31/2006