Provider First Line Business Practice Location Address:
4509 LEMMON AVE.
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:
75219-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-692-6500
Provider Business Practice Location Address Fax Number:
214-265-1570
Provider Enumeration Date:
01/25/2007