Provider First Line Business Practice Location Address:
5939 HARRY HINES BLVD.
Provider Second Line Business Practice Location Address:
PROFESSIONAL OFFICE BUILDING 2, SUITE 600
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75390-5688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-645-5505
Provider Business Practice Location Address Fax Number:
214-645-5639
Provider Enumeration Date:
12/01/2006