Provider First Line Business Practice Location Address:
6621 FANNIN ST, SUITE A2210
Provider Second Line Business Practice Location Address:
TEXAS CHILDRENS HOSPITAL / PEM DEPT
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-824-2271
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007