Provider First Line Business Practice Location Address:
3737 DACOMA ST
Provider Second Line Business Practice Location Address:
C/O MHMRA NORTHWEST COMMUNITY SERVICE CENTER
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77092-8905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-970-8577
Provider Business Practice Location Address Fax Number:
713-970-8421
Provider Enumeration Date:
06/12/2007