Provider First Line Business Practice Location Address:
3906 LEMMON AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75219-3734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-520-8970
Provider Business Practice Location Address Fax Number:
214-520-8980
Provider Enumeration Date:
08/31/2006