Provider First Line Business Practice Location Address:
1121-19 UPTOWN PARK BLVD
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:
77056-3226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-782-8100
Provider Business Practice Location Address Fax Number:
713-621-6261
Provider Enumeration Date:
03/31/2006