Provider First Line Business Practice Location Address: 
6404 INTERNATIONAL PKWY
    Provider Second Line Business Practice Location Address: 
SUITE 2100
    Provider Business Practice Location Address City Name: 
PLANO
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
75093-8225
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
972-267-1988
    Provider Business Practice Location Address Fax Number: 
972-267-3434
    Provider Enumeration Date: 
12/05/2006