Provider First Line Business Practice Location Address:
6720 BERTNER AVE
Provider Second Line Business Practice Location Address:
ST LUKE'S EPISCOPAL HOSPITAL, 7SOUTH
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:
781-974-9356
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2005