Provider First Line Business Practice Location Address:
1123 LEHALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-4911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-790-1314
Provider Business Practice Location Address Fax Number:
713-790-9296
Provider Enumeration Date:
01/05/2006