Provider First Line Business Practice Location Address: 
8313 SOUTHWEST FWY
    Provider Second Line Business Practice Location Address: 
SUITE 109
    Provider Business Practice Location Address City Name: 
HOUSTON
    Provider Business Practice Location Address State Name: 
TX
    Provider Business Practice Location Address Postal Code: 
77074-1611
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-981-0400
    Provider Business Practice Location Address Fax Number: 
713-773-9088
    Provider Enumeration Date: 
08/07/2009