Provider First Line Business Practice Location Address: 
18400 KATY FWY STE 470
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77094-1287
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
281-492-7827
    Provider Business Practice Location Address Fax Number: 
281-646-1416
    Provider Enumeration Date: 
05/23/2019