Provider First Line Business Practice Location Address:
5602 MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KATY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77494-6325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-299-4440
Provider Business Practice Location Address Fax Number:
210-299-4442
Provider Enumeration Date:
09/24/2008