Provider First Line Business Practice Location Address: 
1475 FM 1960 BYPASS RD E
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HUMBLE
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77338-3909
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-532-7311
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/18/2011