Provider First Line Business Practice Location Address:
3601 N MACGREGOR
Provider Second Line Business Practice Location Address:
SUITE 240 QUENTIN MEASE HOSPITAL
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-873-3878
Provider Business Practice Location Address Fax Number:
713-873-3874
Provider Enumeration Date:
08/31/2006