Provider First Line Business Practice Location Address:
1801 NORTH LOOP W STE 45
Provider Second Line Business Practice Location Address:
MEDICAL PLAZA 3
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77008-1445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-308-0508
Provider Business Practice Location Address Fax Number:
832-844-0707
Provider Enumeration Date:
07/08/2010