Provider First Line Business Practice Location Address:
1100 W 34TH ST
Provider Second Line Business Practice Location Address:
PHARMACY
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77018-6206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-842-4324
Provider Business Practice Location Address Fax Number:
713-867-7833
Provider Enumeration Date:
07/18/2005