Provider First Line Business Practice Location Address:
10023 SOUTH MAIN SUITE C-9
Provider Second Line Business Practice Location Address:
MAIN MEDICAL PLAZA
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77025-5252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-496-1077
Provider Business Practice Location Address Fax Number:
713-791-1710
Provider Enumeration Date:
11/16/2005