Provider First Line Business Practice Location Address:
1500 S MAIN ST
Provider Second Line Business Practice Location Address:
JOHN PETER SMITH HOSPITAL - DEPT. FAMILY MEDICINE
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-4917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-926-1235
Provider Business Practice Location Address Fax Number:
817-852-8445
Provider Enumeration Date:
10/04/2010