Provider First Line Business Practice Location Address: 
7601 W SAM HOUSTON PKWY S STE 300
    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: 
77072
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-396-3056
    Provider Business Practice Location Address Fax Number: 
888-565-2928
    Provider Enumeration Date: 
07/10/2008