Provider First Line Business Practice Location Address:
2130 E LEDBETTER DR
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:
75216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-374-3559
Provider Business Practice Location Address Fax Number:
214-376-6975
Provider Enumeration Date:
10/31/2006