Provider First Line Business Practice Location Address:
12221 MERIT DR
Provider Second Line Business Practice Location Address:
SUITE 1500
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75251-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-217-1911
Provider Business Practice Location Address Fax Number:
214-217-1912
Provider Enumeration Date:
06/21/2009