Provider First Line Business Practice Location Address:
1313 CAMPBELL RD
Provider Second Line Business Practice Location Address:
BLDG C
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-973-8245
Provider Business Practice Location Address Fax Number:
713-973-0545
Provider Enumeration Date:
11/08/2006