Provider First Line Business Practice Location Address: 
2 CHELSEA 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: 
77006-6202
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
713-795-4145
    Provider Business Practice Location Address Fax Number: 
713-795-0565
    Provider Enumeration Date: 
07/31/2014