Provider First Line Business Practice Location Address:
5425 POLK ST
Provider Second Line Business Practice Location Address:
SUITE J, ATTN BILLING OFFICE
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77023-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-767-3000
Provider Business Practice Location Address Fax Number:
713-767-3049
Provider Enumeration Date:
11/28/2006