Provider First Line Business Practice Location Address:
3626 N HALL ST
Provider Second Line Business Practice Location Address:
SUITE 623
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75219-5107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-528-3722
Provider Business Practice Location Address Fax Number:
214-528-3724
Provider Enumeration Date:
07/31/2006