Provider First Line Business Practice Location Address: 
3400 BISSONNET ST
    Provider Second Line Business Practice Location Address: 
SUITE 285
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77005-2155
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-663-7447
    Provider Business Practice Location Address Fax Number: 
713-663-7042
    Provider Enumeration Date: 
08/04/2006