Provider First Line Business Practice Location Address:
2221 W 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:
75224-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-234-8444
Provider Business Practice Location Address Fax Number:
214-234-8448
Provider Enumeration Date:
01/27/2012