Provider First Line Business Practice Location Address:
2223 WEST LOOP S
Provider Second Line Business Practice Location Address:
ROOM 643
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77027-3588
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-439-6000
Provider Business Practice Location Address Fax Number:
713-439-6134
Provider Enumeration Date:
08/25/2006