Provider First Line Business Practice Location Address: 
1050 GEMINI
    Provider Second Line Business Practice Location Address: 
STE 202
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77058
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
346-800-1370
    Provider Business Practice Location Address Fax Number: 
346-800-1377
    Provider Enumeration Date: 
12/13/2005