Provider First Line Business Practice Location Address: 
15000 BELLAIRE BLVD STE D
    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: 
77083-2514
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
281-575-6000
    Provider Business Practice Location Address Fax Number: 
281-575-6018
    Provider Enumeration Date: 
06/28/2011