Provider First Line Business Practice Location Address: 
3003 SOUTH LOOP W
    Provider Second Line Business Practice Location Address: 
SUITE 400
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77054-1301
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-521-0053
    Provider Business Practice Location Address Fax Number: 
713-660-0957
    Provider Enumeration Date: 
10/12/2006