Provider First Line Business Practice Location Address: 
1140 BUSINESS CENTER DR STE 202
    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: 
77043-2741
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-461-5808
    Provider Business Practice Location Address Fax Number: 
713-973-0853
    Provider Enumeration Date: 
08/13/2006