Provider First Line Business Practice Location Address: 
1 BAYLOR PLZ
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77030-3411
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-798-6362
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/04/2022