Provider First Line Business Practice Location Address:
3500 GASTON AVE
Provider Second Line Business Practice Location Address:
BAYLOR UNIV MEDICAL CENTER
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75246-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-393-7211
Provider Business Practice Location Address Fax Number:
214-823-2426
Provider Enumeration Date:
06/26/2007