Provider First Line Business Practice Location Address:
C/O MICHEAL E. DEBAKEY VA MEDICAL CENTER
Provider Second Line Business Practice Location Address:
2002 HOLCOMBE BLVD
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-794-7201
Provider Business Practice Location Address Fax Number:
713-794-7786
Provider Enumeration Date:
09/21/2006