Provider First Line Business Practice Location Address:
3500 W WHEATLAND RD
Provider Second Line Business Practice Location Address:
2ND FLOOR, OUTPATIENT BLDG
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75237-3460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-947-0278
Provider Business Practice Location Address Fax Number:
214-947-0279
Provider Enumeration Date:
04/15/2009