Provider First Line Business Practice Location Address: 
427 W 20TH ST
    Provider Second Line Business Practice Location Address: 
SUITE 700
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77008-2433
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-861-8191
    Provider Business Practice Location Address Fax Number: 
713-861-5026
    Provider Enumeration Date: 
11/03/2005