Provider First Line Business Practice Location Address:
3436 S POLK ST
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:
75224-3804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-371-2815
Provider Business Practice Location Address Fax Number:
214-371-0606
Provider Enumeration Date:
11/17/2006