Provider First Line Business Practice Location Address:
642 UPTOWN BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR HILL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75104-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-637-5100
Provider Business Practice Location Address Fax Number:
972-637-5101
Provider Enumeration Date:
12/13/2005