Provider First Line Business Practice Location Address:
TEXAS DEPT. OF STATE HEALTH SERVICES HSR 6-5 SOUTH
Provider Second Line Business Practice Location Address:
5425 POLK, SUITE J
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77023-1497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-767-3019
Provider Business Practice Location Address Fax Number:
713-767-3049
Provider Enumeration Date:
04/27/2007