Provider First Line Business Practice Location Address:
3131 LEMMON AVE E
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:
75204-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-978-0101
Provider Business Practice Location Address Fax Number:
214-978-0121
Provider Enumeration Date:
09/22/2008