Provider First Line Business Practice Location Address: 
2411 FOUNTAIN VIEW DR
    Provider Second Line Business Practice Location Address: 
STE. 200
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77057-4817
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-620-4000
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/29/2013