Provider First Line Business Practice Location Address: 
7700 SAN FELIPE
    Provider Second Line Business Practice Location Address: 
STE 340
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77063-1613
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-781-4072
    Provider Business Practice Location Address Fax Number: 
713-952-4801
    Provider Enumeration Date: 
10/04/2006