Provider First Line Business Practice Location Address: 
4545 POST OAK PLACE DR
    Provider Second Line Business Practice Location Address: 
SUITE 130
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77027-3164
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-960-8008
    Provider Business Practice Location Address Fax Number: 
713-960-0965
    Provider Enumeration Date: 
06/15/2006