Provider First Line Business Practice Location Address:
18300 KATY FWY STE 275
Provider Second Line Business Practice Location Address:
MEDICAL OFFICE BUILDING 2
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77094-1521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-461-1013
Provider Business Practice Location Address Fax Number:
713-461-1593
Provider Enumeration Date:
10/16/2006