Provider First Line Business Practice Location Address: 
11700 KATY FWY STE 300
    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: 
77079-1218
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
281-925-0950
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
01/26/2018