Provider First Line Business Practice Location Address:
3110 LE BADIE 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:
77026-2623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-678-8016
Provider Business Practice Location Address Fax Number:
713-678-7138
Provider Enumeration Date:
01/31/2008