Provider First Line Business Practice Location Address: 
12377 MERIT DR STE 900
    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: 
75251-3102
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
214-758-8000
    Provider Business Practice Location Address Fax Number: 
214-758-8153
    Provider Enumeration Date: 
08/29/2012